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Tiwabwork Tekalign,1 Mistire Teshome Guta,2 Nefsu Awoke,2 Tesfaye Yitna Chichiabellu,2 Mengistu Meskele,3 Gubay Anteneh,4 Tilahun Saol Tura,2 Shimelash Bitew Workie3 1School of Nursing, College of Medicine and Health Science, ArbaMinch University, ArbaMinch, Ethiopia; 2School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3School of Public health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 4School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, EthiopiaCorrespondence: Tiwabwork Tekalign, Email tiwabworkt@gmail.comBackground: Diabetic kidney disease (DKD) develops in nearly half of patients with type 2 diabetes mellitus (DM) and one-third of those with type 1 DM during their lifetime. The incidence of DKD as a cause of end stage renal disease is increasing each year. So this study aimed to assess the time to develop diabetic nephropathy and predictors among diabetic patients treated in Wolaita zone hospitals.Methodology: A ten-year retrospective cohort study had conducted among 614 diabetic patients using systematic random sampling in Wolaita and Dawuro zone hospitals. Bivariable and multivariable Cox proportional hazards regression had used to identify the possible associations between variables. Those variables with a p-value of less than 0.25 in bivariable analysis exported to multivariable Cox regression analysis. Finally, variables with p-value less than 0.05 at multivariable Cox regression were considered significantly significant. The Cox-proportional hazard model assumption had checked using the Schoenfeld residual test.Results: Of the total participants, 93 (15.3%; 95% CI = 12.45– 18.14) patients had developed nephropathy in 820,048 people year observation. A mean time to diabetic nephropathy in this study was 189.63 (95% CI, 185.01, 194.25) months. Being illiterate (AHR: 2.21, 95% CI: 1.34– 3.66), being hypertensive (AHR: 5.76, 95% CI: 3.39– 9.59), and being urban dwellers (AHR: 2.25, 95% CI: 1.34– 3.77) increases the hazard of nephropathy.Conclusion: According to this follow-up study, the overall incidence rate is substantially high over ten year follow-up period. The mean time to develop diabetic nephropathy was sixteen years. Educational status, place of residence, and being hypertensive were the predictors. So stakeholders should work on complication reduction measures and awareness creation of the impact of comorbidities.Keywords: chronic disease, complication, survival analysis, longitudinal study, high blood sugar

Aklilu Alemu,1 Mengistu Meskele,1 Tadele Dana Darebo,1 Tilahun Beyene Handiso,1 Amene Abebe,1 Kebreab Paulos2 1School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Midwifery, Wolaita Sodo University, Wolaita Sodo, EthiopiaCorrespondence: Kebreab Paulos, Email kebreabpaulos@gmail.comObjective: This study aimed to assess perceived HIV stigma and associated factors among adult ART patients in Wolaita Zone, Southern Ethiopia.Methods: A facility-based cross-sectional study was conducted among 638 participants selected using a multistage sampling technique from July 10 to September 2020. A 12-item short version of the HIV stigma scale was used to measure HIV-related stigma. Data were collected by the interview method using a pre-tested questionnaire. Binary and multivariable logistic regression analyses were performed to identify the factors associated with the outcome variable. The strength and direction of the association were measured using the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was declared at P-value < 0.05.Results: In this study, 57.8% (95% CI = 54.1%-61.9%) of people under HIV care perceived high stigma and 450 (70.5%) disclosed their HIV status. Widowed marital status (AOR = 2.984; 95% CI = 1.728– 5.155), primary education (AOR = 3.36; 95% CI = 2.072– 5.42), undisclosed HIV status (AOR = 1.657; 95% CI = 1.121– 2.451), poor social support (AOR: 2.05; 95% CI = 1.195– 3.433), and being member of an HIV support group (AOR: 0.396; 95% CI = 0.249– 0.630) were significantly associated with perceived stigma.Conclusion: The perceived stigma is high among adult ART patients in the study setting. Widowed marital status, primary education, undisclosed HIV status, membership to the social support network NEP+ and poor social support were predictors of perceived HIV stigma. Thus, ART patients should be given more psychosocial support to minimize their perceived public HIV-related stigma.Keywords: adult, ART, HIV, patients, people living with HIV, perceived stigma

Nigussie Boti Sidamo,1– 3 Kassa Daka Gidebo,1 Yohannes Dibaba Wado,4 Amene Abebe,1 Mengistu Meskele1 1Department of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2Department of Reproductive Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3Department of Public Health, PHARMA College Wolaita Sodo Campus, Wolaita Sodo, Ethiopia; 4African Populations and Health Research Center, Nairobi, KenyaCorrespondence: Nigussie Boti Sidamo; Mengistu Meskele Email Hanehalid@gmail.com; mengistu77@gmail.comBackground: Healthcare providers play a critical role in the provision of sexual and reproductive health services for adolescents. In Ethiopia, due to different reasons, including healthcare providers associated reasons, most unmarried adolescents are not accessing the services. However, little is known about healthcare providers’ perception towards the provision of SRH services for unmarried adolescents. This study aimed to explore healthcare provider perception towards the provision of SRH services to unmarried adolescents in Gamo zone, Southern Ethiopia.Methods: A qualitative phenomenological research design was used in May 2021. Fifteen healthcare providers (HCPs) working in adolescent and youth sexual and reproductive health centers were involved in this study. A purposive sampling technique was used to select healthcare providers assuming they are “information-rich” regarding the phenomenon of interest. Inclusion of the study participants was continued until data saturation is reached. To analyze the data, we used inductive thematic analysis, method, and main themes, which captured the diverse views and feelings of the participants. To maintain the trustworthiness of the data, we used dependability, transferability, conformability, and credibility.Results: In this study, individual-level attributes such as healthcare provider’s personal belief, attitude, and motivation; community-level influences like socio-cultural norms, religious reasons, and lack of parental support; and health system setbacks like shortage of essential medical supplies and lack of training are identified as major obstacles in the provision of sexual and reproductive health services for unmarried adolescents.Conclusion: Provision of sexual and reproductive health services for unmarried adolescents is constrained by the interplay of factors acting at an individual level, community level, and health system level. The Ministry of Health (MOH), program planners and policymakers are recommended to give due attention to fulfill the necessary inputs, improving healthcare provider’s attitude and skill and engagement of religious and community leaders to create a safe and supportive environment for providing sexual and reproductive health services to unmarried adolescents.Keywords: healthcare provider, perception, sexual and reproductive health services, unmarried adolescents, Gamo Zone, Southern Ethiopia

Gemechu Ameya,1 Gelila Biresaw,2 Hayat Mohammed,3 Abebayehu Chebud,4 Melese Meskele,5 Mohammed Hussein,6 Muktar Endris7 1Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia; 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3Department of Medical Laboratory Science, College of Medicine and Health Science, Jimma University, Jimma, Ethiopia; 4Melka Oda Primary Hospital, West Guji, Melka Sodo, Ethiopia; 5Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia; 6Dessie Selam General Hospital, Dessie, Ethiopia; 7Galikoma Health Center, Afar Region, Galikoma, EthiopiaCorrespondence: Gemechu AmeyaDepartment of Medical Laboratory Sciences, College of Medicine and Health Sciences, Kotebe Metropolitan University, P.O. Box: 3268, Addis Ababa, EthiopiaTel +251-91-783-7681Email gemechuameya@gmail.comBackground: Epistaxis is one of the most common otorhinolaryngological emergencies affecting the majority of the population in their lifetime, with some of them requiring serious medical attention. This study aimed to assess the prevalence and associated factors of epistaxis among pre-college students in Wolaita Sodo, Ethiopia.Methods: An institution-based cross-sectional study was conducted. Data were collected using a pre-tested interviewer administered questionnaire. The study participants were selected by systematic random sampling technique. A logistic regression analysis was employed to assess the presence and strength of association factors with epistaxis. An adjusted odds ratio with 95% confidence interval was used to determine the presence and strength of the association at 0.05 level of significance.Results: Of 387 participants, 57.1% of them were male, and the mean age of all participant was 18.05± 1.401 SD years. The overall epistaxis prevalence was 108 (27.9%). Blood group O, which accounted for about 43.4% was more prevalent. Blood group O (AOR=3.96, 95% CI=1.5– 10.4), participants who drink coffee daily (AOR=2.75, 95% CI=1.0– 7.4), and participants who took a bath frequently with both hot and cold-water (AOR=4.55, 95% CI=1.1– 18.6) were significantly associated with epistaxis.Conclusion: The type of blood group, interval of coffee drinking, and type of bathing were significantly associated with epistaxis. Working on the identified associated factor and increased awareness about epistaxis for the students with effective first aid training is mandatory.Keywords: epistaxis, blood group, southern Ethiopia, pre-college students

Mengistu Meskele,1,2 Nelisiwe Khuzwayo,3 Myra Taylor1 1School of Nursing and Public Health, Discipline of Public Health, Durban, KwaZulu-Natal, South Africa; 2School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3School of Nursing and Public Health, Discipline of Rural Health, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Mengistu Meskele Email mengistu77@gmail.comBackground: Intimate partner violence is a crime against humanity. This study aimed to explore the experiences and challenges in screening for intimate partner violence among women who use antiretroviral therapy and other health services in Wolaita Zone in Ethiopia.Methods: A descriptive phenomenological qualitative study design was used, and 16 in-depth interviews were conducted with healthcare workers from 19 health facilities who were providing healthcare services in Wolaita Zone. We selected participants purposively until data saturation was reached. Colaizzi’s descriptive phenomenological method was used for the data analysis, and the Open Code software was used to assist with the data coding. We maintained the scientific rigour of credibility, transferability, dependability, and confirmability.Results: Analysis of the study data identified the following five themes: type of IPV identified by HCWs among women, provider-related barriers, healthcare system barriers, patient-level barriers, and providers’ recommendations for improvements. Issues that emerged from these findings were a gap in medico-legal report provision, absence of a separate record-keeping for IPV cases, lack of client follow-up, absence of routine assessment of violence for women who have injuries, and lack of specific coordination with an external organisation. Moreover, the absence of staff training, weak referral systems, and a shortage of necessary medical equipment challenged IPV screening.Conclusion: This study has shown that there are healthcare provider and health system challenges relating to screening clients for intimate partner violence in Wolaita Zone. Provision of separate record-keeping of intimate partner violence cases in the healthcare facilities, standardising the medico-legal reporting system, improving women’s access to education, and executing more gender-equitable policies, are needed. Moreover, the inclusion of intimate partner violence-specific policy frameworks in national legislation is necessary.Keywords: healthcare workers, intimate partner violence, screening, Wolaita Zone

Daniel Wogu, Tsegaye Lolaso, Mengistu Meskele School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, EthiopiaCorrespondence: Tsegaye Lolaso Tel +251-935-505-052Email tlolaso71@gmail.comIntroduction: Client satisfaction influences the use of family planning and other reproductive health services. This study aimed to assess the magnitude of client satisfaction with family service and its associated factors among reproductive-age women.Patients and Methods: We conducted a facility-based cross-sectional study. A total of 411 clients, nested in four health facilities, were included in the analysis. Systematic sampling was employed to select study units for the exit interview. Data collection instruments for this study were pre-tested structured questionnaires. Client satisfaction was assessed using fifteen Likert-scaled question items. Each item of question has 5 points ranging from 1 (strongly disagree) to 5 (strongly agree) and, finally, mean was computed. The pre-coded data were entered into Epi Data version 4.2.0 and exported to SPSS version 25 for analysis. Logistic regression analysis was carried out to identify independently associated factors at a confidence interval of 95% and a significance level of p-value less than 0.05.Results: Magnitude of client satisfaction with family planning service was 46% [95% CI: 41– 50.8]. Rural residence [AOR=3.07; 95% CI: 1.10– 8.62], educational level of college and above [AOR=0.22; 95% CI: 0.07– 0.70] as compared to the educational level of primary education, waiting time of less than half an hour [AOR=7.80; 95% CI: 2.48– 24.48], maintaining privacy [AOR=7.16; 95% CI: 2.89– 17.69], describing side effects of methods [AOR=3.14; 95% CI: 1.02– 9.76] were factors significantly associated with client satisfaction.Conclusion: The overall magnitude of client satisfaction with the services was found to be low. Many of the factors that attributed to the low level of client satisfaction are modifiable. There is a need for organizing the family planning room as per standards, maintaining privacy, minimizing waiting time, and describing the side effects during the provision of service.Keywords: client satisfaction, family planning service, Southern Ethiopia

Mihiretu Alemayehu, Mengistu Meskele School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Introduction: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. Methodology: A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multi-stage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value

Introduction: Evidence indicates that postpartum and post-abortion women accept family planning at a higher rate when offered timely at appropriate sites. Therefore, this study explored barriers and enablers of postpartum and post-abortion family planning utilization in primary health care units of Wolaita Zone, Southern Ethiopia, from June 20 to July 25, 2022., Methods: We used a case study strategy of qualitative research using both the Consolidated Framework for Implementation Research (CFIR) and Gender, Youth, and Social Inclusion (GYSI) frameworks was conducted from June to July 2022. We conducted 41 in-depth and key informant interviews and six focus group discussions. We also used Open Code software version 4.02 for coding and further analysis and applied a framework analysis., Results: The analysis of this study identified barriers and enablers of postpartum and post-abortion family planning service uptake in five CFIR domains and four GYSI components. The barriers included misconceptions and sole decision-making by husbands, cultural and religious barriers, and healthcare providers paying less attention to adolescents and husbands, which prevented them from using immediate postpartum and postabortion family planning services. The health facilities were not adequately staffed; there was a shortage and delay of supplies and infrastructure, trained staff turnover, and poor accountability among service providers. The existence of community structure, equal access and legal rights to the service, and having waivered services were enablers for postpartum and post-abortion family planning service uptake., Conclusion and Recommendation: The current study identified various barriers and enablers to the uptake of postpartum and post-abortion family planning. Therefore, there is a need for high-impact interventions such as targeting male partners and girls, ensuring infrastructure, supplies, and equipment, building staff capacity, and making decisions jointly., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Meskele et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The objective of this study is to determine the pooled prevalence of active trachoma among 1-9 years old children in Ethiopia., Design: A systematic review and meta-analysis were employed in accordance with the Preferred Reporting Items for Systematic Reviews., Data Sources: Medline/PubMed, Scopus, Web of Science, African Journal of Online and Google scholar databases were systematically explored to find studies published in English until July 2023., Eligibility Criteria: The following criteria apply: (1) condition (Co): studies examined the prevalence of trachoma among children (1-9) years old; (2) context (Co): studies conducted in Ethiopia; (3) population (Pop): studies that were done among children (1-9) years old; (4) study type: observational studies and (5) language: studies published in English., Data Extraction and Synthesis: The data were extracted using a Microsoft Excel spreadsheet. DerSimonian-Laird random effect model was used to estimate the pooled prevalence of active trachoma among 1-9 years old children. Cochrane Q-tests and I 2 statistics were used across studies to assess heterogeneity. To identify possible publication bias, Egger's test was performed., Primary Outcome: Prevalence of active trachoma among children aged (1-9 years old)"., Results: Overall, a total of 42 articles with 235 005 study participants were included in the final analysis. The estimated pooled prevalence of active trachoma using random effect model was 24% (95% CI 20% to 27%). The subgroup analysis by region revealed that the highest prevalence of trachoma was 36% (95% CI 13% to 58%) in the Tigray region, and publication year revealed the prevalence of trachoma was decreasing from 32% to 19% after 2015., Conclusion: In this review, the pooled prevalence of active trachoma was found to be high in Ethiopia compared with WHO threshold level. This underscores the need for increased focus on high-risk age groups to decrease trachoma and to achieve the elimination of trachoma from the country by 2030., Competing Interests: Competing interests: The review was conducted without any personal or financial relationship that could lead to conflict., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Client satisfaction has been recognized as an essential component in evaluating healthcare quality. In Wolaita Zone, there was a lack of research on the myths, misconceptions, and elements linked to client satisfaction with family planning. This study aimed to assess the myths and misconceptions of family planning and the factors associated with women's satisfaction with family planning services., Methods: We used a mixed methods study design (cross-sectional study design with a phenomenological design of the qualitative study). For the survey, 777 women were selected using multistage sampling, while purposive sampling was used to recruit in-depth interview participants. We used STATA version 15 and NVIVO version 12 software., Results: Only two-thirds, 534 (68.7 %) [95 % CI = 65.4%-71 %] clients, were satisfied with the family planning service. Clients who attended secondary education and above (AOR = 1.84; 95 % CI: 1.07, 3.23) and (AOR = 3.04; 95 % CI: 1.37, 6.72) did not wait to get the service (AOR = 5.11; 95 % CI: 1.98, 13.20), attended family planning service in a facility with convenient working hours (AOR = 4.43; 95 % CI: 2.25-8.74) and with posters in the waiting room (AOR = 3.48; 95 % CI: 1.22-9.94), comfortable with the cleanliness of clinic (AOR = 2.08; 95 % CI: 1.20, 3.94), whose Privacy was maintained (AOR = 9.56; 95 % CI: 5.02, 18.20), who were given information on the possible side effects of a method (AOR = 2.77; 95 % CI: 1.75-4.39), and on how the method works (AOR = 2.57; 95 % CI: 1.49-4.43 ) had higher odds of satisfaction. Also, various myths and misconceptions, such as implants moving to other parts of the body, implants causing paralysis, affecting routine activities, "womb of the woman may not hold the baby", etc., were identified in a qualitative study., Conclusions: Client satisfaction in this study is low. An improved provider approach that suits on-site advocacy and the quality of counselling during the family planning service is needed. There is also a need to improve waiting time, working hours, cleanliness, awareness creation for both couples, and maintaining clients' privacy., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mengistu Meskele reports financial support was provided by EngenderHealth Inc. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Antiretroviral therapy (ART) treatment failure remains a major public health concern, with multidimensional consequences, including an increased risk of drug resistance, compromised quality of life, and high healthcare costs. However, little is known about the outcomes of second-line ART in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the incidence and determinants of second-line ART treatment failure. Articles published in PubMed, Google Scholar, Science Direct, and Scopus databases were systematically searched. All observational studies on the incidence and predictors of treatment failure among patients with HIV on second-line ART were included. A random-effects model was used to estimate the pooled incidence, and subgroup analysis was performed to identify the possible sources of heterogeneity. Publication bias was checked using forest plot, Begg's test, and Egger's test. The pooled odds ratio was also computed for associated factors. Seven studies with 3,962 study participants were included in this study. The pooled incidence of second-line antiretroviral treatment failure was 5.98 (95% CI: 4.32, 7.63) per 100 person-years of observation. Being in the advanced WHO clinical stage at switch (AHR = 2.98, 95% CI: 2.11, 4.25), having a CD4 count <100 cells/mm3 (AHR = 2.14, 95% CI: 1.57, 2.91), poor drug adherence (AHR = 1.78, 95% CI: 1.4, 2.25), and tuberculosis co-infection (AHR = 2.93, 95% CI: 1.93, 4.34) were risk factors for treatment failure. In conclusion, this study revealed that that out of 100 person-years of follow-up, an estimated six patients with HIV who were on second-line antiretroviral therapy experienced treatment failure. The risk of treatment failure was higher in patients who were in an advanced WHO clinical stage, CD4 count <100 cells/mm3, and presence tuberculosis co-infection. Therefore, addressing predictors reduces the risk of treatment failure and maximizes the duration of stay in second-line regimens., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kassie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia., Methods: This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA)., Results: In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57)., Conclusion: Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes., Competing Interests: Declaration of conflicting interestsAll the authors declare that they have no conflict of interest.

Background: Modern medicine is not the choice of patients with "shimetere" in the Gurage community owing to their perception of 'parenteral medication use severely aggravates the disease'. For this reason, the root part of Polygala sadebeckiana Gürke is commonly utilized as traditional medicine in the management of the disease. The aim of this study was to evaluate the antimicrobial activity of Polygala sadebeckiana Gürke extract on bacterial isolates from wound samples of patients with "Shimetere"., Methods: The agar well diffusion method was used to evaluate antibacterial activity, and the agar dilution method was utilized to determine minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MICs). The crude extract was tested against isolated bacteria at concentrations of 25, 50, 75 and 100 mg/mL in triplicate (3x). The positive controls were azithromycin (15 µg) and cloxacillin disk (5 µg), and the negative control was dimethylsulfoxide (5%). The group mean comparisons were made using one-way ANOVA at a significance level of p < 0.05, and the results are presented as the mean ± standard deviation. The presence of secondary metabolites from crude extract was checked by standard testing procedures., Results: S. aureus and S. pyrogen were the two identified bacteria from 9 (60%) and 3 (20%) wound samples, respectively. All identified bacterial strains were susceptible to the reference antibiotics. Tannins and saponins were the most abundant secondary metabolites found in the crude extracts. The average inhibition zones of the plant extracts with 100, 75, 50 and 25 mg/mL concentrations were 27, 20.33, 15.25, and 11.96 mm (p < 0.000) for S. aureus and 30.02, 24.50, 19.07, and 15.77 mm (p < 0.000) for S. pyrogen bacteria, respectively. The MIC and MBC of the crude extract were 1.67 and 10 mg/mL for S. aureus and 0.98 and 4 mg/mL for S. pyrogen., Conclusion: Polygala sadebeckiana Gürke contained significant tannins and saponins as secondary metabolites and had antibacterial activities against isolated bacteria (S. aureus and S. pyrogen) from "Shimetere". The potential mechanism of antibacterial action of the plant extract was cell wall synthesis inhibition., (© 2024. The Author(s).)

Objective: To assess the prevalence of teenage pregnancy and associated factors among teenage schoolgirls aged 15-19 years in Wolaita Sodo town, southern Ethiopia., Design: Cross-sectional survey., Setting: This study was conducted among teenage girls from preparatory and high schools in Wolaita Sodo town, southern Ethiopia, between 1 April and 30 May 2019., Participants: 588 (97.8%) of 601 randomly selected teenage schoolgirls aged 15-19 years (selected via a multistage random sampling technique) participated in the study., Outcome Measures: Teenage pregnancy and associated factors., Results: The prevalence of teenage pregnancy among schoolgirls in Wolaita Sodo town was 14.6% (95% CI 11.9% to 17.7%). The current pregnancy rate was 33.7% (95% CI 23.9% to 44.7%). Having a family history of teenage pregnancy (AOR 3.3; 95% CI 1.3 to 8.4) and access to mass media (AOR 2.5; 95% CI 1.1 to 6.2) were positively associated with teenage pregnancy, while condom use (AOR 0.1; 95% CI 0.03 to 0.5) and knowledge of where to get modern contraceptives (AOR 0.4; 95% CI 0.2 to 0.9) were negatively associated., Conclusions: The prevalence of teenage pregnancy among schoolgirls in Wolaita Sodo was high. Having a family history of teenage pregnancy and access to mass media were positively associated with teenage pregnancy, whereas reported condom use and knowledge of where to get modern contraceptives were negatively associated with teenage pregnancy among schoolgirls., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Fetal macrosomia defined as birth weight of 4000 g and above regardless of gestational age and associated with adverse maternal and fetal outcomes, especially among women in developing countries like Ethiopia. Despite the observed burden, there is limited evidence on determinants of fetal macrosomia. This study aimed to identify determinants of fetal macrosomia among live births at Wolaita Sodo town Southern Ethiopia., Methods: A facility-based matched case-control study design involved 360 singletons deliveries attended at hospitals in Wolaita Sodo town, southern Ethiopia, with 120 cases and 240 controls included. Cases and control were matched by maternal age. Cases were neonates with a birth weight of ≥ 4000, while controls were neonates with a birthweight between 2500gm and less than 4000gm. Data were collected by interviews, measuring, and reviewing mothers' medical documents. Conditional logistic regression analysis was carried to identify the independent predictor variables. Statistical significance was set using a p-value < 0.05 and 95% CI for AOR., Results: Male neonates were four times more likely to be macrosomia than female neonates MAOR = 4.0 [95%CI; 2.25-7.11, p < 0.001]. Neonates born at gestational age ≥ 40 weeks were 4.33 times more likely to be macrosomia with MAOR = 4.33 [95%CI; 2.37-7.91, p < 0.001]. Neonates born from physically inactive mothers were 7.76 times more likely to be macrosomia with MAOR = 7.76 [95CI; 3.33-18.08, p < 0.001]. Neonates born from mothers who consumed fruits and dairy products in their diet frequently were 2 and 4.9 times more likely to be macrosomia MAOR = 2.03 [95%CI; 1.11-3.69, p = 0.021] and AOR = 4.91[95%CI; 2.36-10.23, p < 0.001] respectively., Conclusion: Mothers' physical exercise and consumption of fruit and dairy products were significant predictor variables for fetal macrosomia. Hence, health care providers may use these factors as a screening tool for the prediction, early diagnosis, and timely intervention of fetal macrosomia and its complications., (© 2022. The Author(s).)

Background: Youths have been facing different sexual and reproductive health problems such as HIV infections and unplanned pregnancies. Therefore, this study aimed to assess reproductive health services utilization and their associated factors among Wolaita Sodo University students in Wolaita Sodo, Ethiopia., Methods: We conducted an institutionally-based mixed-method study among 759 regular undergraduate university students. Multistage random sampling and purposive sampling techniques have been used to recruit students for the quantitative and qualitative studies, respectively. A pretested self-administered questionnaire was used to collect the data. A logistic regression model was used for quantitative data analysis, whereas thematic analysis was used for qualitative data. We used open-code software-assisted qualitative data analysis. The statistical significance was declared at a P value less than 0.05., Results: We found that 378 (49.8%) (95% CI: 46.20-53.34) of respondents had utilized sexual and reproductive health services within the 12 months preceding the current survey. Being a first-year student (AOR = 1.57, 95% CI: 1.01-2.46), having ever had sexual intercourse (AOR = 5.12, 95% CI: 3.31, 7.96), participating in peer-to-peer discussion (AOR = 1.46, 95% CI: 1.02-2.02), and having ever had sexual transmitted infection syndrome (AOR = 3.91, 95% CI: 1.41-10.85) have increased the odds of using sexual and reproductive health services., Conclusion: Sexual and reproductive health services utilization among university students was inadequate and affected by several factors. Therefore, strengthening peer support networks and addressing the gap in services were highly recommended., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Muluken Gunta et al.)

Introduction: Nutritional management is a fundamental practice of concern to all patients infected with the human immunodeficiency virus (HIV). The nature of HIV/AIDS and malnutrition impacts are interlocked and intensify one another., Objective: This study aimed to explore nutrition management challenges among people living with HIV on antiretroviral therapy (ART) in primary health centres in Addis Ababa, Ethiopia., Methods and Materials: We used a hermeneutic (interpretive) phenomenological study design. The study used in-depth interviews to describe lived experiences among adult patients aged 18 and above. We selected the participants purposively until the saturation of the idea reached. We maintained the scientific rigor and trustworthiness by applying credibility, transferability, dependability, and conformability, followed by translation and re-reading of the data has been achieved. The data have been analyzed through inductive thematic analysis assisted by NVIVO version 12 pro software., Result: Nutrition management challenges for HIV patients have been described using six significant themes. The major themes were: acceptance of the disease and the health status; facilitators and barriers to treatment adherence; behavioural changes in eating patterns; experience of food insecurity issues; nutrition knowledge; and support. The themes have explained how patients using ART have been challenged to manage their nutrition ever since their diagnosis. Of all challenges, food insecurity is found to be the core reason for poor nutrition management., Conclusion and Recommendation: We found that many factors in managing their nutrition challenged patients with HIV. There should be an increasing interest in managing food insecurity issues as food insecurity has been strongly related to other factors., Competing Interests: The authors have no competing interests.

Background: It is expected that around 50% of individuals with diabetes mellitus will develop hypertension in the course of medical follow-up. However, with strict medical follow-up and adherence to medical advice the incidence of hypertension can be highly reduced and the time to occurrence can be delayed. Therefore, this paper aimed to measure the time to development of hypertension and identify its predictors among a 10-year cohort of diabetic patients who have medical follow-up in health facilities of Gurage Zone., Methods: An institution-based retrospective cohort study was conducted in diabetic follow-up clinics of Gurage Zone by reviewing 540 consecutively selected records among the records enrolled from January 1, 2010 to December 31, 2019. The outcome variable was incidence rate and survival time to the occurrences of hypertension (a systolic blood pressure at or above 140 mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known hypertensive cases taken from adults' age ≥18 years) among admitted diabetic patients (fasting blood sugar ≥126 mg/dL or random blood sugar ≥200 mg/dL). Data were collected using a standardized checklist by trained professionals by reviewing records of all clients ever enrolled. Data were cleaned and entered by Epi info version 7 and analyzed by STATA. A Cox-proportional hazard regression model was built to identify predictors of development of hypertension., Results: A total of 540 clients were followed for different periods with a median follow-up period of 2.3 years which gives 3,200 person-years of observation. Two hundred and seventy-six (51.1%) participants were males and the mean age of was 52.2 (+11.7) years. Three hundred (55.6%) participants were urban dwellers. The overall incidence density rate (IDR) of hypertension in the cohort was 48.6 cases per 1,000 persons-year. Older ages adjusted hazard ratio (AHR)=4.0 (95% CI=2.26-7.82), body mass index (BMI) >25 kg/m 2 AHR=2.3 (95% CI=1.06-3.68), Type II diabetes mellitus (DM) AHR=2.0 (95% CI=1.16-3.04), presence of comorbidity AHR=2.9 (95% CI=1.74-4.58), and poor drug adherence AHR=2.5 (95% CI=1.45-4.65) predicted the development of hypertension., Conclusion: The risk of occurrences of hypertension among diabetic patients was high at the early periods and the risk was less at the late diabetic periods and the incidence density rate of hypertension among diabetic patients was high. In addition, age, BMI, type of DM, comorbidity, and drug adherence were independent predictors of occurrences of hypertension. Therefore, intervention to further reduce its occurrence has to focus on drug adherence and prevention of infection., Competing Interests: The authors declare no conflicts of interest., (© 2021 Migora et al.)

Objectives: The present study undertakes a scoping review aimed to map the evidence of intimate partner violence (IPV) against women living with HIV/AIDS in Africa., Design: We used the online database to identify papers published from 1 January 2009 to 1 April 2019, from which we selected 21 articles from Uganda, Nigeria, Kenya, South Africa, Zambia, Ethiopia, Cameroon, Tanzania and Swaziland that used IPV as an outcome variable among women living with HIV/AIDS., Data Sources: PubMed, MEDLINE, EBSCO host, Google Scholar., Eligibility Criteria: We included women who were aged 15 years and above, living with HIV/AIDS in sub-Saharan Africa., Data Extraction and Synthesis: We conducted the abstract screening with two independent reviewers. We also performed full-text screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The Mixed Method Appraisal Tool was used to determine the quality of the studies. We used NVIVO software V.12 to undertake a thematic analysis., Results: Of the studies, the majority, 57.1%, reported cross-sectional results. In comparison, 23.8% examined qualitative studies, 9.5% were clinical trials, 4.8% were cohort studies and the remaining 4.8% covered grey literature. This review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, proof of the association of sociodemographic characteristics with IPV and implications for practice. Moreover, the review revealed that following the serostatus disclosure, there is evidence of heightened risk for IPV., Conclusions: This study found evidence of IPV among women living with HIV/AIDS. The HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Therefore, further research is needed to promote action to reduce IPV among HIV-positive and HIV-negative women and to determine healthcare workers' IPV screening experience., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Ethiopia is one of the nations which has an enormous burden of intimate partner violence (IPV), and where it is usually difficult to talk about HIV separately from IPV., Objectives: This research aimed to explore the lived experience of IPV against women using antiretroviral therapy (ART) and other outpatient services in Wolaita Zone, Ethiopia METHODS: We used an Interpretive (hermeneutic) Phenomenological Analysis design among purposively selected adult women aged 18-49 years. A total of 43 women participated in this study, of whom 30 were using ART, and 13 women were using other health services. We used an in-depth interview and focus group discussions until data saturation, while conscious of the need to maintain the scientific rigor, dependability, and credibility. The data were transcribed verbatim and translated into English. We read the transcripts repeatedly to understand the content. We used NVivo 11 software to assist with data organisation, and also, we used the framework analysis method., Results: We identified five themes, namely: "women's terrifying experiences of violence," "the effect of violence on women's health," "support/lack of support /partner's controlling behaviours," "women's feelings about the available services," and "IPV prevention strategies from the perspective of women." Interviewees described their violent experiences which included wife-beating, being stigmatised in front of others, having material thrown at the woman's face, wife's hand and teeth were broken, forced sex, restriction of movement, name-calling, threats to hurt, being insulted, being left alone, and the withdrawal of finances. The negative health impacts reported included abortion, infection with HIV and other sexually transmitted diseases, disability, child's death, and depression. The disclosure of HIV test information resulted in violence. Inappropriate punishment of the perpetrator and the lack of a supportive women's network to avert IPV were perceived as legal limitations., Conclusions: IPV is a considerable health burden, varying in its presentation and its negative impact on women's health. Improved laws should provide justice for all victims. Establishing a women's network to assist women at risk of violence, should be emphasised. Unwise HIV test result disclosure leads to IPV; hence HIV disclosure should be facilitated through health care providers.

Objectives: This study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia., Methods: A comparative cross-sectional study design was used to interview the 816 women between 18-49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 4.4.2.0) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented., Results: The lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93-13.42],income [AOR = 3.97; 95% CI:1.81-8.72], bride price payment [AOR = 3.46; 95% CI:1.74-6.87], women's decision to refuse sex [AOR = 2.99; 95% CI: 1.39-6.41],age group of women [AOR = 2.86; 95% CI:1.67-4.90], partner's family choosing wife [AOR = 2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36-4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36-4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05-3.19]., Conclusions: There is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Among women living with HIV, intimate partner violence (IPV) is increasingly recognised worldwide as a serious public health concern. The understanding of the link between IPV and HIV is currently inconclusive and information concerning the IPV experiences of HIV-infected women is insufficient. This protocol aims to map evidence of IPV against women living with HIV/AIDS in Africa., Methods and Analysis: We will search and review peer-reviewed and review articles. The comprehensive search will include the electronic databases PubMed, MEDLINE with full text via EBSCO host, Google Scholar, Science Direct and Scopus. The advanced search will use MeSH terms. Grey literature will also be included. The titles of the studies from the database searches will be screened, and duplicates will be removed. The abstract screening will be done independently by two reviewers, followed by the full-text screening which will be based on the eligibility criteria. The six methodological stages in this review will be to: identify the research questions; identify relevant studies; select the studies; chart the data; collate, summarise and report the results; and thereafter undertake consultations. The quality of studies included in the review will be determined by the Mixed Methods Appraisal Tool. NVIVO software V.11 will be used to undertake a thematic analysis of each of the studies and to extract the relevant outcomes., Dissemination: The results of this study will be disseminated through publication, and presented at conferences related to IPV., Scoping Review Registration: Currently, a scoping review is not eligible for registration on the International Prospective Register of Systematic Reviews., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Anemia, the world's most common micro-nutrient deficiency disorder, can affect a person at any time and at all stages of life. Though all members of the community may face the problem, children aged 6-23 months are particularly at higher risk. If left untreated, it adversely affects the health, cognitive development, school achievement, and work performance. However, little was investigated among young children in Sub-Saharan countries including Ethiopia. This research aimed to investigate its magnitude and correlates to address the gap and guide design of evidence based intervention., Methods: A community-based cross-sectional study was conducted from May -June 2016 in rural districts of Wolaita Zone. Multi-stage sampling technique was applied and 990 mother-child pairs were selected. Socio-demography, health and nutritional characteristics were collected by administering interview questionnaire to mothers/care-givers. Blood samples were taken to diagnose anemia by using HemoCue device, and the status was determined using cut-offs used for children aged 6-59 months. Hemoglobin concentration below 11.0 g/dl was considered anemic. Data were analyzed with Stata V14. Bivariate and multivariable logistic regressions were applied to identify candidates and predictor variables respectively. Statistical significance was determined at p-value < 0.05 at 95% confidence interval., Results: The mean hemoglobin level of children was 10.44±1.3g/dl, and 65.7% of them were anemic. Among anemic children, 0.4% were severely anemic (<7.0g/dl), while 28.1% and 37.2% were mildly (10.0-10.9g/dl) and moderately (7.0-9.9g/dl) anemic, respectively. In the multivariable analysis, having maternal age of 35 years and above (AOR = 1.96), being government employee (AOR = 0.29), being merchant (AOR = 0.43) and 'other' occupation (AOR = 3.17) were correlated with anemia in children in rural Wolaita. Similarly, receiving anti-helminthic drugs (AOR = 0.39), being female child (AOR = 1.76), consuming poor dietary diversity (AOR = 1.40), and having moderate household food insecurity (AOR = 1.72) were associated with anemia in rural Wolaita., Conclusion: A large majority of children in the rural Wolaita were anemic and the need for proven public health interventions such as food diversification, provision of anti-helminthic drugs and ensuring household food security is crucial. In addition, educating women on nutrition and diet diversification, as well as engaging them with alternative sources of income might be interventions in the study area., Competing Interests: The authors have declared that no competing interests exist.

Background: Ethiopia has adopted the global plan to end the epidemic of HIV/AIDS. The aim of this study was to assess the progress made towards achieving this plan., Methods: A review and analysis of national population-based surveys, surveillance, and routine programme data was executed. The data analysis was conducted using Excel 2016 and Stata 14 (StataCorp LP, College Station, TX, USA)., Results: Between 2011 and 2016, the number of HIV-related deaths dropped by 58%, while that of new HIV infections dropped by only 6%. Discriminatory attitudes declined significantly from 77.9% (95% confidence interval (CI) 77.3-78.4%) in 2011 to 41.5% (95% CI 40.6-42.4%) in 2016. Around 79% of adult people living with HIV (PLHIV) were aware of their HIV status; 90% of PLHIV who were aware of their HIV status were taking antiretroviral treatment (ART) and 88% of adult PLHIV on ART had viral suppression in 2016. The proportion of people aged 15-49 years who had ever been tested for HIV and had received results increased from 39.8% (95% CI 39.2-40.4%) in 2011 to 44.8% (95% CI 44.2-45.4%) in 2016. This proportion was very low among children below age 15 years at only 6.2% (95% CI 5.9-6.5%). Among regions, HIV testing coverage varied from 13% to 72%. Female sex workers had lower coverage for HIV testing (31%) and ART (70%) than the national average in the adult population. International funding for HIV dropped from more than US$ 1.3 billion in 2010-2012 to less than US$ 800 million in 2016-2018., Conclusions: Ethiopia is on track to achieve the targets for HIV testing, ART, viral suppression, and AIDS-related deaths, but not for reductions in new HIV infections, discriminatory attitudes, and equity. Ending the epidemic of HIV/AIDS requires a combined response, including prevention and treatment, tailored to key populations and locations, as well as increased funding., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Family Planning is often taken as one of the "Magic Bullet" interventions owing to its high impact and wide reaching nature in achieving multiple goals. This study aimed to assess the current status and the factors associated with health post level Implanon service provision through trained health extension workers in Wolaita zone, southern Ethiopia. Materials and methods: A cross sectional study was conducted among trained health extension workers in Wolaita zone in February 2013. A simple random sampling technique was used to identify a total of 285 trained HEWs. First bivariate, then multivariate logistic regression model along with 95% confidence interval was used to see the independent effect of factors associated with current Implanon service provision by the health extension workers. Results: Currently, the number of Implaon providing trained health extension workers in Wolaita was 264(45.8%). Distance of health post from district health offices and health center, turnover of trained health extension workers in the health post, interest of trained health extension workers in providing Implanon and their job satisfaction to serve as a health extension workers and availability of service delivery guidelines and teaching aids were associated with the current provision of Implanon by health extension workers. Conclusion: Implanon provision among trained health extension workers was affected by different factors. Hence, improving the working conditions of trained health extension workers, regular and periodic facilitative supervision, availing service delivery guidelines and improvement of health management information system are recommended.

Background: The use of long acting and permanent contraceptive methods (LAPMs) has not kept step with that of short-acting methods such as oral pills and injectable in Africa. This study explores the association between women's awareness, attitude and barriers with their intention to use LAPMs among users of short term methods, in Southern Ethiopia., Methods: A cross-sectional study design of mixed methods was conducted in the public health facilities of Wolaita zone, Southern Ethiopia, in January 2013. Women who were using short term contraceptive methods were the study population (n = 416). Moreover, 12 in-depth interviews were conducted among family planning providers and women who have been using short term methods. Data were entered into EPI Info version 3.5.3 and exported to SPSS version 16.0 for analysis. The odds ratios in the binary logistic regression model along with 95% confidence interval were used., Results: One hundred fifty six (38%) of women had the intention to use LAPMs while nearly half of them (n = 216) had a negative attitude to use such methods. Moreover, two-third of study participants (n = 276) held myths and misconceptions about such methods. The women who had a positive attitude were found to be 2.5 times more intention to use LAPMs compared to women who had a negative attitude (AOR =2. 47; 95% CI: 1.48- 4.11). Women who had no myths and misconceptions on LAPMs were found to be 1.7 times more intention to use LAPMs compared to women who had myths and misconceptions (AOR = 1.71; 95% CI: 1.08- 2.72). Likewise, women who attained secondary and higher level of education were found to be 2 and 2.8 times more intention to use LAPMs compared to women with no education, respectively (AOR = 2. 10; 95% CI: 1.11- 3.98) and AOR = 2. 80; 95% CI: 1.15- 6.77)., Conclusions: Intention to use LAPMs was low and nearly half of women had a negative attitude to use such methods. Positive attitude, absence of myths and misconceptions on LAPMs and secondary and plus level of education predicts intention to use LAPMs. Educating communities to change the attitude, myths and misconceptions on LAPMs should be aggressively done.

Background: Antiretroviral treatment (ART) was provided to more than nine million people by the end of 2012. Although ART programs in resource-limited settings have expanded treatment, inadequate retention in care has been a challenge. Ethiopia has been scaling up ART and improving retention (defined as continuous engagement of patients in care) in care. We aimed to analyze the ART program in Ethiopia., Methods: A mix of quantitative and qualitative methods was used. Routine ART program data was used to study ART scale up and patient retention in care. In-depth interviews and focus group discussions were conducted with program managers., Results: The number of people receiving ART in Ethiopia increased from less than 9,000 in 2005 to more than 439, 000 in 2013. Initially, the public health approach, health system strengthening, community mobilization and provision of care and support services allowed scaling up of ART services. While ART was being scaled up, retention was recognized to be insufficient. To improve retention, a second wave of interventions, related to programmatic, structural, socio-cultural, and patient information systems, have been implemented. Retention rate increased from 77% in 2004/5 to 92% in 2012/13., Conclusion: Ethiopia has been able to scale up ART and improve retention in care in spite of its limited resources. This has been possible due to interventions by the ART program, supported by health systems strengthening, community-based organizations and the communities themselves. ART programs in resource-limited settings need to put in place similar measures to scale up ART and retain patients in care.

Background: Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive, debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-led treatment approach appropriate for resource poor settings has been developed, comprising (1) education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap, water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5) emphasis on the consistent use of shoes and socks., Methodology/principal Findings: We did a 12-month, non-comparative, longitudinal evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and (2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients completed follow up. Characteristics of patients completing follow-up were not significantly different to those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference -0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to -2.74), respectively, p<0.001 for both changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-significant change in proportion of patients with mossy lesions (p = 0.375)., Conclusions/significance: This simple, resource-appropriate regimen has a considerable impact both on clinical progression and self-reported quality of life of affected individuals. The regimen appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend that further research in the area include analysis of cost-effectiveness of the regimen.

Podoconiosis is a geochemical condition resulting in lower limb elephantiasis similar to that seen in chronic filarial disease. In podoconiosis-endemic areas, diagnosis of the condition must often take place in the community setting, where laboratory facilities are unavailable. In this study, 205 patients in Wolaitta zone, southern Ethiopia, were examined according to standard clinical practice. A capillary blood sample was taken at midnight for thick film examination. In a subsample of 117 patients, rapid antigen testing using Binax antigen cards was also performed. Both tests were negative in all patients. In podoconiosis-endemic areas, clinical examination is a valid means of diagnosing podoconiosis.

HIV has played a key role in TB, modifying its incidence and clinical presentation. This study describes the prevalence of HIV among TB patients attending health facilities in the southern region of Ethiopia. The HIV prevalence was 18% for female and 21% for male TB patients. 15% and 30%, respectively, of the rural and urban patients with TB were HIV positive (p<0.05). 19% (51/261) smear-positive PTB, 26% (36/137) smear-negative PTB and 11% (10/94) of the extrapulmonary TB patients were HIV positive. The proportion of patients with extra-PTB varied from 11% to 38% across the centres and was highest in the zones with the lowest HIV prevalence. In the light of limited diagnostic facilities, clinicians often make a clinical diagnosis of TB without laboratory confirmation. The increase in the number of TB cases could be due to HIV. However, the number of health facilities offering TB treatment in the area also increased (from 53 to 236) during the same period and the increase in TB is likely to be the result of a combination of factors, including improved detection and HIV. It is important to consider this multi-factorial phenomenon when interpreting the increase of TB in a geographical area.

The survey was undertaken to establish the point prevalence of overt podoconiosis (endemic non-filarial elephantiasis) in Wolaitta zone, Southern Ethiopia, and also to determine whether age- or sex-related prevalence differences exist. A cross-sectional survey was performed during May-September 2001 among 33 678 residents of 4210 households randomly selected from all seven woredas (administrative districts) of Wolaitta zone. Trained data collectors administered a simple questionnaire and examined household residents for signs of podoconiosis. Of the residents 1890 had overt signs of podoconiosis. The mean zonal prevalence weighted for the woreda size was 5.46%. Most of cases (64%) occurred in the economically productive age groups (16-45 years). The male:female ratio was 1:0.98, reflecting the gender ratio of the zone. Podoconiosis is an important chronic public health problem affecting both men and women in areas of irritant soil. Further research is necessary to establish the economic effects of the condition.