Master of Public Health in Epidemiology
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Item 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 TESFAYEBackground: 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.Item 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 LAMISOBackground: 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.Item 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 BEYENEBackground: 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 settingsItem Factors associated with lost-to-follow-up among adult hypertensive patients in Holeta town, Central Ethiopia 2024.(hawassa universty, 2024-05) Demshu AdugnaBackground: - 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