Master of Public Health in Epidemiology

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    Uncontrolled hypertension And Associated Factors Among Adult Hypertensive Patients Attending on Follow up At Public Health Facilities Hawassa City Administration Hawassa, Sidama Region Ethiopia,
    (hawassa universty, 2024-05) TEKETEL NEGASH
    Background: Uncontrolled hypertension refers to systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, even when patients are on anti-hypertension medication. Repeatedly unrecognized risk factor that contributes to putting many people into various complex health problems. It can lead to kidney, heart disease, brain, and other diseases, and sudden death. Objective: To assess the magnitude of uncontrolled hypertension and associated factors among adult hypertensive patients attending in follow-up at public health facilities in Hawassa city administration Methods: A cross-sectional study was carried out, from March to April 2024 including 411 hypertensive patients older than 18 years. The study was carried out at public health facilities at Adare General Hospital, Motiti Fura Primary Hospital Millennium Health Centre, Alamura Health Centre in the chronic follow up unit in the Hawassa city administration. Data were collected through patient interviews and patients’ medication record reviews. Descriptive statistics, bivariable and multivariable logistic regression were used to assess the association between independent and dependent variables. The output of the analysis is presented using adjusted odds ratio with 95% confidence interval. Result: Out of the 422 hypertension patients who were selected, the study's direct participants, 411 of whom had a 2.6% refusal rate (n = 11), The prevalence of uncontrolled hypertension was 55.7% (n = 229) 95%CI= CI = 50.8–60.6) in the study were in the age group of <60 years57.9% (n=238) After adjusting for other determinants, age, ≥60 years (AOR=3.287 95% CI: 2.043-5.288). diet-nonadherence (AOR=2.95, 95% CI: 1.592 5.475) physical activity (AOR=1.803 95% CI: 1.079-3.014).and co-morbidity (AOR = 2.737, 95% CI: 1.612-4.647) are found to be statistically significant predictors of uncontrolled hypertension Conclusions and recommendation: There were, Age, diet non adherence, nonphysical exercise adherence and co-morbidity, which are independently predicted. Advise patients to follow suggestions for lifestyle adjustments to improve hypertension self-management.
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    DETERMINANTS OF CUTANEOUS LEISHMANIASIS IN GAMO ZONE, SOUTH ETHIOPIA- UNMATCHED CASE CONTROL STUDY A RESEARCH THESIS SUBMITTED TO HAWASSA UNIVERSITY, COLLEGE OF MEDICINE AND HEALTH SCIENCES, PUBLIC HEALTH ACADEMIC AND SERVICE DIRECTORATE, IN PARTIAL FULFILMENT OF MASTER OF PUBLIC HEALTH IN FIELD EPIDEMIOLOGY
    (hawassa universty, 2024-05) SEMALIGNNEGUSSE YOHANNES LIGISO
    Background: Leishmaniasis represents a major health problem for the public with a wide range of clinical symptoms, epidemiological variety, and a spectrum of aggressiveness with cutaneous leishmaniasis type being the commonest across the world, especially in developing countries. Up to 1.5 million cases are recorded annually, and more than 350 million individuals are thought to be at risk of cutaneous leishmaniasis. Gamo Zone is one of those areas in Ethiopia currently hit by high burden of the disease, but did not get the necessary attention due to different reasons. Objectives: This study aimed to assess the determinants of cutaneous leishmaniasis in Deramalo and Dita districts of Gamo Zone, South Ethiopia. Methods and Materials: Unmatched case control study design was used in this study. Total of 285 participants with 95 cases and 190 controls with case to control ratio of 1:2 were included. A structured questionnaire adapted from previous literatures was used to collect the data by electronic tool with Kobo Collect. The collected data were exported and cleaned in MS excel, and were imported to SPSS for descriptive and regression analyses. Variables having significant association with development of cutaneous leishmaniasis were tested by binary logistic regression and P-value of 0.25 in bivariable logistic regression was used to select candidate variables for multivariable logistic regression. AORs were calculated at 95% CI to determine the variables having significant associations with CL, and variables having p-value of <0.05 were declared to have significant associations and hence determinants of CL. Results: A total of 285 participants with 95 cases and 190 controls were included in this study and the response rate was 100%. The mean age of the cases was 21.42 and the mean age of the controls was 28.45. Moreover, age categories of less than 20 years (AOR=3.15; 95% CI: 1.42-6.95) and 20 to 34 years (AOR=3.4; 95% CI: 1.4-8.8), availability of gorges in the vicinity (AOR=2.51; 95% CI: 1.22-5.13), presence of active cutaneous leishmaniasis case in the household (AOR=9.27; 95% CI: 4.23-20.33), and presence of previous cutaneous leishmaniasis scar cases in the household (AOR=4.49; 95% CI: 2.03 9.96) were found to be significantly associated with CL.
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    INCIDENCE AND PREDICTORS OF LOSS TO FOLLOW UP AMONG ADULTS ON ANTIRETROVIRAL THERAPY AT PUBLIC HEALTH FACILITIES IN HAWASSA, SIDAMA REGION, ETHIOPIA, 2024
    (hawassa universty, 2024-06) RUTH TESFAYE
    Background: Despite significant progress in treatment and prevention, the global HIV/AIDS pandemic remains a serious threat to public health. HIV-related mortality and morbidity have greatly decreased as a result of ART, transforming HIV into a chronic, manageable condition. However, loss to follow-up hinders efforts to manage the HIV pandemic and is a substantial challenge. Objectives: The objective of this study was to determine the incidence and predictors of loss to follow up among adults on ART in Hawassa, Sidama, Ethiopia 2024. Methods: An institution-based retrospective follow up study was conducted. The study utilized data from four selected ART clinics, collected retrospectively on 459 study participants from September 11, 2018 to September 11, 2023. A simple random sampling technique was employed. Data were extracted from patients' charts and registration books using KOBO Toolbox and exported to SPSS for analysis. The incidence of LTFU was calculated using cumulative incidence and incidence density rates. Kaplan-Meier survival curves were employed, providing insights into LTFU patterns. Predictors of LTFU were determined using multivariable Cox proportional-hazard regression. Result: A total of 459 participants were included in the study, contributing 1386 person years of follow-up. The cumulative incidence of loss to follow-up (LTFU) was 16.6%, with an incidence density rate of 5.48 per 100 person-years [95% CI: 4.37- 6.86]. Significant predictors of LTFU included younger age groups (AHR 2.77, 95% CI: 1.06 - 7.19), lack of education (AHR 4.08, 95% CI: 1.34 - 12.43), WHO stage III (AHR 3.06, 95% CI: 1.04 - 8.99), WHO stage IV (AHR 4.64, 95% CI: 1.82 - 11.85), and being bedridden (AHR 3.63, 95% CI: 1.42 - 9.32). These factors were identified as significant predictors of LTFU in this cohort of ART patients in Hawassa, Ethiopia. Conclusions: This study found that the incidence of LTFU was moderate relative to certain global and local findings. Age, education, WHO clinical stage, functional status and CPT treatment are found significant predictors of LTFU. These findings highlight the need for targeted interventions to address the specific challenges faced by the identified vulnerable groups.
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    TREND, AND IMMEDIATE OUTCOMES OF TRANSCATHETER CLOSURE VERSUS SURGICAL LIGATION OF PDA IN CHILDREN WHO UNDERGONE CLOSURE OF PDA AT THE CARDIAC CENTER OF ETHIOPIA FROM 2012 TO 2022: COMPARATIVE CROSS-SECTIONAL STUDY.
    (hawassa universty, 2023-10) MOHAMMED NASIR
    Background: The Ductus arteriosus is an important fetal structure that helps in reducing right ventricular afterload during fetal life, but the patent ductus arteriosus (PDA) often closes spontaneously after birth. To prevent complications from patent ductus arteriosus, transcatheter closure (TC)and surgical ligation (SL) are management options for PDA that have not spontaneously closed. TC is preferred nowadays in older children and adults and SL in infants. However, the magnitude of the complications and outcomes associated with transcatheter closure (TC) and surgical ligation (SL) of PDA vary across studies. In this study, the trend, and immediate outcomes of TC of PDA versus SL of PDA were compared. Methodology:This study was conducted on children under 18 years ofage who underwent TC and SL of PDA at a cardiac center in Ethiopia (CCE) from January1, 2013, to January1, 2022, by retrospectively reviewingtherecords from February 1, 2022, to June 1, 2022.664 patients who underwent PDA closure, (n=316) in theTCgroup and (n=348) patients in the SL group were included in this study.Trend analysis was performed using theCochrane-Armitage test to test for linear trends. The propensity scoresmultivariable logistic regression model used in the mainanalysis considered the following variables:EchocardiographicPDAsize, age at diagnosis, age at surgery,gender, weight at surgery, height at surgery, and presence of severe pulmonary hypertension. Usingthe inverse probability of treatment weighting (IPTW) by propensity score and after adjusting for baseline variables, the Man U test, chi-square test, and Fisher's exact test were used to compare the complications and outcomes of SL and TC of PDA. Results: There was a linear trend in both transcatheter closure and surgical ligation of PDA. The SC-group patients were younger, lighter, and shorter and more proportion of patients had severe pulmonary hypertensionOverall complications were significantly higher with PDA surgical ligation compared with transcatheter closure ((112 (35.4%vs286 (71.9%)), p-value = 0.001)). Total mechanical ventilationtime, ICU stay, and hospital stay were higher in the surgical ligationgroup with ap-value of 0.001 each. vii | P a g e Conclusion: Transcatheter closure of PDA is a good and safe alternative to surgical ligation of PDA with reduced overall complication and shorter mechanical ventilation time, lower ICU stay, and lower hospital stay.
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    THE LEVEL OF ROUTINE HEALTH INFORMATION SYSTEM DATA QUALITY AND ASSOCIATED FACTORS AT PUBLIC HOSPITAL IN SILTE ZONE, CENTRAL REGION, ETHIOPIA, 2023
    (hawassa universty, 2023-11) NIGUSSIE DUKAMO
    Background: Routinely collected data of poor quality can compromise the validity of effect evaluations and lead to poor decision-making, inappropriate resource allocation, and a loss of trust in the health system. Routine health information system data are seen as poor in quality and are not used for decisions in Ethiopia, and continues to be a significant problem. Objectives: To assess the level and associated factors of routine health information system data quality; and explore the factors affecting data quality at public hospitals in Silte Zone, Central Region Ethiopia, 2023 Methods and materials: Facility based mixed method with an embedded study design was conducted. A total of four public hospitals, 32 units or departments, 605 health care workers, and 12 key informant interviews were selected. Simple random sampling and purposive sampling techniques were used for selecting study participants in quantitative and qualitative study. The data was entered into Epi-data version 4.4, open code 4.03 and exported to SPSS version 26, and descriptive statistics were used to assess the level of data quality, and Binary logistic regression and thematic analysis was run to identify factors affecting data quality. Adjusted odds ratios with 95% confidence intervals and themes or subthemes were reported. Result: The overall study conducted facility data quality level was 90.84%; completeness and consistence of data in this study were 85.5% and 85.3% respectively. Easily understandability of registration and report format [AOR 1.92; CI 1.11-3.33], receive training [AOR 1.62; CI 1.07- 2.44], getting supervision [AOR 1.66 CI 1.05-2.61], provide regular feedback [AOR 1.72 CI 1.07- 2.75], team’s work appreciated and valued by supervisors [AOR 1.61; CI 1.04-2.75] and decisions and follow up actions identified in Performance monitoring team meetings [AOR 1.73; CI 1.12- 2.67] were significantly associated with data quality ; and thematic analysis was done and categorized into four themes and twelve sub-themes. Conclusion and recommendation: The level of data quality at the public hospital in Silte Zone is almost equal to the national expected level of data quality, but completeness &consistency of the data were lower than the national expected level. For MOH and other supporting organization to fully transforming the paper based service registration to an electronic-based medical recording system in which it will reduce incompleteness and inconsistency of data and to increase data quality
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    ASSESSMENT OF MAGNITUDE, AND ASSOCIATED FACTORS OF MATERNAL MORBIDITY IN NORTHERN ZONE OF SIDAMA REGION, ETHIOPIA: A COMMUNITY BASED CROSS-SECTIONAL STUDY.
    (hawassa universty, 2024-05) NEGASH LAMISO
    Background: Globally, maternal morbidity and mortality remain major public health problems. For every woman that dies of maternal causes, there are at least 20 more women who suffer from infection, disabilities, and injuries relating to pregnancy and childbirth. Despite the increasing magnitude of maternal morbidity in Ethiopia, only a few studies have been conducted in a community-based setting to determine the magnitude and risk factors for maternal illness. Objective: The aim of this study was to assess the magnitude and associated factors of maternal morbidity during pregnancy, delivery, and postnatal in Northern Zone of Sidama Regional state. Methods: A community-based cross-sectional study design was conducted, in which a secondary data that was used. A total of 2044 mothers were included in analyses. Data were collected using the Kobo data collection tool. It was extracted and exported to SPSS Version 26 for cleaning and analysis. Bivariate and multivariable logistic regression was done. Statistically significant results were considered at a confidence interval of 95% and a p-value of < 0.05 Result: The prevalence of maternal morbidity was 21.4% (95%CI [19.8, 23.4]) of women who reporting at least one morbidity during their last pregnancy, delivery and postpartum. Factors associated with maternal morbidity were women in poorest,[AOR=1.7,95%CI (1.22,2.4)],house wife,[AOR =1.98, 95%CI(1.01,3.89)], daily worker and trade [AOR= 2.13, 95%CI (1.07, 4.22)], parity ≥7 [AOR=2.45, 95%CI (1.26, 4.79)], assisted vaginal delivery[AOR=4.6,95%CI (2.26, 9.37)], cesarean section [AOR=1.64, 95%CI (1.07, 2.51)], and duration of labor (>12hrs) [AOR =1.48, 95%CI (1.13, 1.95)]. Conclusions: There is a high prevalence of maternal morbidity among women during pregnancy, childbirth and the postpartum. Factors such as being poorest, house wife and daily worker/trader), parity, operative delivery and assisted vaginal delivery and duration of labor are associated with an increased risk of maternal morbidity. Recommendation: Access to quality maternal health care services, education on complications of pregnancy and childbirth, and improvement of overall maternal health outcomes by early detection and management of risk factors could help reduce the prevalence of maternal morbidity.
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    TREND AND ASSOCIATED FACTORS OF HIGH FERTILITY RATE IN ETHIOPIA. USING DEMOGRAPHIC HEALTH SURVEY DATA FROM 2000-2019: MULTILEVEL ANALYSIS MODEL
    (hawassa universty, 2024-01) MESFIN BEYENE
    Background: High fertility rate remains one of the most important determinants playing a key role in changing the size and structure of the population of a given nation over time. Even if there were a declining trend in last few years, like many African countries, the fertility rate of Ethiopia is still high, make the nation as the second most populous nation in Africa, after Nigeria. Therefore, this study was aimed to analyze the magnitude, trend and determinants of high fertility (number of children ever born alive ≥ 5) among reproductive-age women in Ethiopia using the Demographic Health Surveys conducted from 2000 to 2019. Method: The trend with cross-sectional study design operated using data from the Ethiopian demographic health survey from 2000 to 2019. A total weighted sample of 44,596 women of reproductive ages were included in the analysis from the latest 2016 EDHS data to compute the magnitude and identify the determinants of high fertility. Multilevel logistic regression analysis assessed the relationship between high fertility and its determinants using STATA software (version 16; StataCorp, College Station, TX). Trend analysis of high fertility assessed using the extended Mantel- Haenszel Chi-square test for linear trend using the OpenEpi (V.3.01) response program and the adjusted odds ratio (AOR) with the 95% confidence interval was computed, and a significant association was declared at p value ≤ 0.05. Results: The magnitude of high fertility was 64.6 % (95 % CI, 64.10 - 65.01). The multilevel logistic regression model reviled that high fertility were significantly associated with residing in rural area [AOR = 3.90, 95% CI: 2.85-5.34], lack of formal education [AOR=2.21; 95%CI:1.93 2.53], never used any contraceptive [AOR=1.38; 95% CI:1.24-1.53], early marriage [AOR=2.42; xi 95% CI: 2.11-2.78], childbearing at early age [AOR=2.70; 95% CI: 2.44-3.00], polygamous marriage [AOR=1.47; 95% CI:1.30-1.65], short birth intervals of ≤36 months [AOR=2.36; 95% CI:2.17-2.56] and husband low education status [AOR=3.64; 95%CI:2.12-4.27]. But women with a met contraceptive need [AOR = 0:28, 95% CI: 0.08, 0.93] were less likely to have high fertility. Conclusions: The finding of this study implies that sixty-five out of hundred women in this survey reported having high fertility, and the magnitude and trend did also show significant change during the last two decades. Key determinants of high fertility were early marriage and childbearing at early ages, lack of formal education, low rate of family planning use, polygamous marriage status, short birth intervals of ≤36 months, and unmet needs for family planning that needs public health attention. It is recommended to stakeholders develop new approaches to deal with the primary causes of high fertility factors. Special attention should also be done on improving the Adolescents and Youth Sexual and Reproductive Health (AYSRH) services focused on rural settings
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    UTILIZATION OF LONG LASTING INSECTICIDAL NETS AND ASSOCIATED FACTORS IN BORICHA AND BILATE ZURIA WOREDA, SIDAMA REGION, SOUTHERN ETHIOPIA: CROSS SECTIONAL STUDY
    (hawassa universty, 2023-11) MESELE ALARO
    Background: Malaria is a major cause of mortality and morbidity in developing countries. Sleeping under long lasting insecticidal nets (LLIN) is the most widely adopted preventive measure against malaria. LLINs represent a cost effective means of malaria prevention for at risk populations. Even though there have been studies indicating the utilization of LLIN use in Southern Ethiopia, there is no study conducted in Sidama region, Boricha and Bilate Zuria Woredas. Objective: The objective of this study was to assess utilization and associated factors of long lasting insecticidal nets in Boricha and Bilate Zuria Woredas, Sidama, Ethiopia in 2023. Methods: A community based cross sectional study was conducted in Boricha and Bilate Zuria woredas from February to March 2023. A total of 726 households were included in the study. A multi stage sampling technique was used to obtain the intended sample size. Quantitative data were collected using a structured questionnaire using face to face interview. The collected data were entered using Epi data version 3.1, and finally analyzed using SPSS version 20. Binary logistic regressions were computed to identify associated variables with the utilization of LLIN. Variables having P value < 0.25 in bi-variable analysis were candidate for multivariable analysis. Variables with P-Value <0.05 were declared as independent predictors of LLIN utilization at alpha 5%. Results: The proportion of people utilizing LLIN was 85.5% with 95% CI of (82.5% - 88.1%). Having one LLIN (AOR= 3.55; 95% CI of (1.92, 6.57) compared to two and more LLIN and family size of less than 5 persons (AOR= 0.60; 95% CI 0.37, 0.96) compared to 5 and more persons were independently associated with LLIN utilization. Conclusions: Percentage of long-lasting insecticide-treated nets (LLINs) that were used by anyone the night before the study was high compared to the national 62.3% according to malaria indicator survey of 2015. It was significantly associated with number of LLIN and family size.
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    PREVALANCE OF Taenia saginata IN HUMAN AND Cysticercus bovis INFECTION IN CATTLE AND PUBLIC HEALTH SIGNIFICANT AT ADOLA DISTRICT EAST GUJI ZONE, SOUTHERN OROMIA, ETHIOPIA
    (hawassa universty, 2024-10) HUSSEN CHEMERI BERISO
    Taeniasis and bovine cysticercosis are common parasitic infections in developing countries like Ethiopia. The purpose of this study was to assess and estimate the prevalence of Taenia saginata in human and c. bovis in cattle the public health significance and financial losses due to meat borne parasite in Adola district and surrounding areas of Guji zone, Oromia regional state. This work involved active abattoir survey, Questionnaire survey and Human stool sample examination, sampling and laboratory investigation was carried out in a period from December 2023 to June 2024.While abattoir survey was conducted at Adola municipital Abattoir by applying ante and postmortem inspections. Stool samples were collected from Adola General Hospital and Adola Health center and microscopically examined for the presence of Taenia spp egg to obtain required data. Questionnaire surveys were also used to assess the perception and knowledge of community, health professionals and Taenia saginata suspected group about taeniasis and bovine cysticercosis. From a total of 422 cattle carcass inspected using active abattoir survey, 6.87 % were found positive for c.bovis. On basis of Questionnaire survey, of total 95 respondents interviewed through face to face, the prevalence of Taenia saginata infection was 72.5% have experience. moreover, out of 384 stool samples examined; the overall prevalence of Taenia spp egg was 14.58%. Taenia saginata infection was found higher in old age group (17.4%) followed by adult (17.1%) and young age (10.2%) (P>0.05) .The results of the present study clearly indicated the economic as well as public health significances of the infection due to bovine cystcercosis and taeniasis respectively. Thus, interdisciplinary teamwork between veterinarians and medical personnel is essential to help in the control of this problem
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    Factors associated with lost-to-follow-up among adult hypertensive patients in Holeta town, Central Ethiopia 2024.
    (hawassa universty, 2024-05) Demshu Adugna
    Background: - This study is significant since non-communicable diseases are becoming more prevalent in developing nations, such as Ethiopia. Blood pressure is the primary problem that almost all developing nations face this challenge. To prevent hypertension-related damage and other consequences, it is important that people with hypertension have regular follow-up care. The aim of this study was to determine the causes of follow-up discontinuation among adult hypertensive patients. Method: - We used facility based unmatched case-control study in the town from April 08-May 07/2024. The data was collected by structured questionnaires which adapted from previously used questionnaires. We collect data within a month. A questionnaire was administered by an interviewer to gather data from both cases and controls. Before we started data collection, we had to code each questionnaire. There were consistency and cross-validation checks. The data was collected by Kobo Toolbox and export and analysis was done by SPSS version 20. Result:- A total of 282 respondents—94 cases and 188 controls—participated in the study; participants were between the mean age and Standard divisions of 52.59+11.05 for cases and 50.4+11.17 for controls; male respondents were 54.7% of cases and 56.8% of controls, respectively. Lack of community health insurance (AOR=2.992, 95%CI [1.646, 5.440]), Opinion of thinking hypertension is curable (AOR=2.551, 95%CI [1.265, 5.145]) and waiting time > 1hr (AOR=3.634, 95%CI [2.008, 6.577]) significantly associated with the lost to follow-up. Discussion: - In this study, the factors associated to lost to follow-up among hypertensive patients drop out of follow-up care were identified. From those the factors like: - waiting time at health facility, community health insurance enrollment, Patients knowledge of hypertension treatment and follow up duration. Therefore, The Holeta town health Office and health facilities working with making patients with raised blood pressure beneficiaries of community health insurance service give health education on treatment follow up and improve waiting time of the patients in health facilities