Master of Public Health

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Start date: 2024End date: 2024

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    REPRODUCTIVE HEALTH SERVICE UTILIZATION AND BURDEN OF PROBLEMS AMONG WOMEN WITH DISABILITIES IN SIDAMA REGION, ETHIOPIA
    (Hawassa University, 2024-05) ZELALEM TENAW BOGALE
    Background: Women with disabilities are more likely to experience unintended pregnancy and sexual violence. However, there is no enough evidence about contraceptive utilization, unintended pregnancy, sexual violence and determinant factors among reproductive-age women with disabilities in Ethiopia. This knowledge gap is particularly pronounced in rural settings and among individuals with disabilities beyond the categories of the young, blind, and deaf. Additionally, the influence of contextual factors on these aspects remains inadequately explored. Therefore, this study aimed to assess reproductive health service utilization and burden of problems among women with disabilities in Central Sidama (Dale and Wonsho districts and Yirgalem city administration) Region, Ethiopia. Methods: A community-based disability-specific house-to-house census was conducted from May 1-30, 2022, to determine the reproductive-age of women with disabilities. After the census, a cross-sectional study design was used from June 20 to July 15, 2022, to investigate reproductive health service utilization and burden of problems, and their determinants (Objectives I, II, and III). The sample sizes were determined independently for each objective. Specifically, 620 reproductive-age females with disabilities participated in Objective I, 363 women with disabilities participated in Objective II, and 652 reproductive-age females with disabilities participated in Objective III. I allocated the sample size proportionally to the 30 randomly selected kebeles. A multi-stage stratified cluster sampling technique was used to select the study participants. Pretested structured and unstructured data collection tools were used, and face-to-face interview was conducted. The data was collected using the Kobo Collect application version 2021.3.4. After collection, the data were imported into Stata version 16 for analysis. A descriptive and multilevel binary logistic regression analysis model was applied. Then, bi-variable multilevel logistic regression was done to identify eligible variables (P-value<0.20) for multivariable multilevel logistic regression analysis. A P-value of <0.05 and a 95% confidence level were used to determine statistical significance. Results: Among reproductive-age females with disabilities, 27.3 % (95% CI: 23.8 %, 31.0 %) were current contraceptive users. Of the users, 82 (48.5%) used implants. The odds of contraceptive utilization is (AOR=9.03; 95% CI: 4.39, 18.6) times higher among reproductive age women who have good contraceptive knowledge compared to their counterparts. Reproductive -age women with disabilities who have transport accessibility to health facilities are (AOR=2.28; 95% CI: 1.32, 3.94) times more likely to use contraceptives compared to those who have no transport access to health facilities. Compared to young reproductive-age (15 to 24 years old) women with disabilities, those aged 25 to 34 years are (AOR=3.04; 95% CI: 1.53, 6.04) times higher odds of contraceptive utilization. Reproductive-age women with a hearing disability have (AOR = 0.38; 95% CI: 0.18, 0.79) lower chance of contraceptive utilization. Similarly, those with paralysis of the extremities (AOR = 0.06; 95% CI: 0.03, 0.12) demonstrate a lower chance of contraceptive utilization, while reproductive-age women using a wheelchair also showed (AOR = 0.10; 95% CI: 0.05, 0.22) lower chance of contraceptive utilization compared to reproductive-age women with vision disability (Objective I). The prevalence of current (most recent) unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). Compared with poor income tercile, women who have a middle-income tercile have (AOR = 2.07; 95% CI: 1.02, 4.20) times higher risk for unintended pregnancy. Women with disabilities who gave birth (AOR = 2.20; 95% CI: 1.21, 3.99) have a higher risk of unintended pregnancy compared to those who have not given birth. The risk of unintended pregnancy is (AOR = 0.26; 95% CI: 0.12, 0.57) lower among women with extremity paralysis compared with vision disability. Compared with rural resident women with urban residents have (AOR = 0.22; 95% CI: 0.12, 0.40) a lower risk of unintended pregnancy. Women with disabilities who drink alcohol have (AOR = 0.28; 95% CI: 0.11, 0.74) a lower risk of unintended pregnancy when compared with those who did not drink alcohol (Objective II). On the other hand, the prevalence of lifetime sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Reproductive-age women with disabilities who reside in urban settings have (AOR = 0.51; 95% CI: 0.29, 0.88) a lower risk of sexual violence compared to their counterparts in rural settings. Compared with young (15 to 24 years old) reproductive-age women with disabilities, those aged 25 to 34 years have (AOR = 5.9; CI: 3.01, 11.6) times higher risk of sexual violence. Similarly, reproductive-age women with disabilities aged 35 to 49 years have (AOR = 3.47; CI: 1.48, 8.14) times higher risk of sexual violence. Reproductive-age women with disabilities having no sexuality information have (AOR = 11.3; CI: 6.24, 20.5) times higher risk of sexual violence compared to their counterparts who have sexuality information. and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence (Objective III). Conclusion: This study revealed that the burden of unintended pregnancy and sexual violence among reproductive-age women with disabilities are high. Moreover, contraceptive utilization among reproductive-age females with disabilities is low. Contraceptive knowledge, age, transport accessibility, and types of disability determine contraceptive utilization. On the other hand, parity, residency, income, alcohol utilization, and types of disability were the determinant risk factors of unintended pregnancy. Also, age, residency, sexuality information, and types of disability were the determinant factors of sexual violence. Therefore, it is essential to design and implement strategies for raising contraceptive awareness and incorporating at-home contraceptive provision strategies into health extension programs to enhance contraceptive utilization. Furthermore, strengthening education and information dissemination about contraceptive utilization, reproductive health problems and its prevention strategies in rural settings are vital to mitigate unintended pregnancy and sexual violence.
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    Calcium-containing Eggshell Powder Supplementation to Mitigate Toxic Effects of Excess Fluoride Intake among Women in Ethiopian Rift Valley: Efficacy, association, safety and acceptability
    (Hawassa University, 2024-11) Demmelash Mulualem Zewdie
    Background: Worldwide, 50 million people suffer from fluorosis, which affects not only teeth, but also bones, joints, gut and brain functions. In Ethiopia, where defluoridation requires costly infrastructure, more than 14 million individuals, mainly in the Rift Valley, are affected by fluorosis. Drinking water sources, in the Rift Valley of Ethiopia, contain fluoride (F) levels exceeding the World Health Organization (WHO) limit of 1.5mg/L. F exposure may be an added concern for women’s bone and dental health where there is low Ca intake. Studies suggest that the adverse effects of F can be reversed or lessened by providing sufficient food intake of protein, calcium (Ca), anti-oxidants and vitamin D. Of these, Ca is the most studied by ecological studies. However, there have been no intervention studies of Ca to mitigate fluorosis at the community level in Ethiopia. We therefore hypothesized that supplementation of an age old, sustainable and low cost source of Ca, i.e., eggshell, as a dietary Ca source would mitigate the toxic effects of excess F intake in women. Thus, the aim of this study was to test the efficacy of calcium-containing ESP supplementation, as a proof of concept, to reduce F absorption as measured by urinary F excretion (a primary outcome measure) and mitigation of fluorosis symptoms (secondary outcomes) in women living in a fluorosis-affected area. The overall objective of this PhD research was to assess efficacy, association and safety and acceptability of calcium-containing eggshell powder supplementation to mitigate toxic effects of excess fluoride intake among women in Ethiopian Rift Valley. Methods: Women (n=270) from two villages provided clinical and questionnaire data for the cross-sectional survey. Dental fluorosis examination was done using Dean’s Index, and skeletal and non-skeletal fluorosis assessment was carried out using physical tests and clinical symptoms. Daily Ca intake was estimated by a food frequency questionnaire. Food, drinking water and beverage samples were analyzed for F level. Eighty-two women (41 Intervention Group, IG; 41 Control Group, CG) were recruited for the Phase II clinical trial; 39 in each group completed the trial. Morning spot urine was collected for testing fluoride (F), calcium (Ca) and creatinine concentrations, before (baseline, BL) and after (endline, EL) the intervention that was 6-months daily supplementation with 2.4 gram calcium-containing eggshell powder/ESP (providing ~1000 mg of calcium). Dental, skeletal and non-skeletal fluorosis assessments were carried out at BL and, except for dental, at EL. For the purpose of safety and acceptability assessment, body retention of iron and zinc were measured using blood levels, prior to and after the calcium containing ESP supplementation among the study subjects. Occurrence of side effects such as nausea, vomiting, constipation, and abdominal bloating and gas related to excess calcium intake in the Phase II trial were assessed using checklists on a monthly period. In addition, blood tests for malaria, hemoglobin and hematocrit were done immediately in the field. Descriptive statistics, bivariate and multivariable logistic regression, relative risk (RR), paired samples t-test and two independent samples t-test, linear generalized estimating equation (GEE) and multivariate analysis of the GEE model were used to analyze and compare outcomes between groups. Results: Many subjects (56.3%) exhibited dental fluorosis. Women having ≤ 400 mg/day Ca intake had ~3 times greater odds of developing skeletal rigidity with joint pains [AOR=2.8, 95%CI: 1.6, 5.0] and muscular weakness [AOR=2.9, 95%CI: 1.3, 6.3] compared to those with higher intakes. At EL, women in the IG had about six-fold lower urinary F excretion [β = - 6.1 (95% CI: -7.1, -5.1)] compared to women in the CG. The risk of developing skeletal fluorosis tested using the ability to bend body and touch floor or toe [RR = 0.21 (95% CI: 0.07, 0.69)], and stretch and fold arms to touch back of head [RR = 0.18 (95% CI: 0.04, 0.77)] were significantly reduced in the intervention group by 79% and 82% respectively compared with the control. Majority of the women in IG reported mitigation of pain and muscular symptoms of non-skeletal fluorosis ranging from lowest RR = 0.17 (95% CI: 0.05, 0.52) to highest RR = 0.59 (95% CI: 0.39, 0.88) after the calcium-containing ESP supplementation than in CG. Conclusion: Signs and symptoms of dental, skeletal and non-skeletal fluorosis were prevalent in women of child-bearing age in this area of the Rift Valley of Ethiopia. As low dietary Ca intake was significantly associated with symptoms related to skeletal and non-skeletal fluorosis, this warrants nutritional intervention on calcium intakes in this setting. A significant reduction in urinary F excretion and reduction in many fluorosis symptoms were observed among women supplemented with calcium-containing ESP, thus providing evidence for using this dietary calcium (ESP) source for mitigation of fluorosis. Safety and acceptability assessments conducted as part of the study indicated that calcium-containing eggshell powder supplementation was generally accepted, well-tolerated and did not pose significant risks to the health of participants. The potential feasibility, sustainability and safety of using home prepared crushed eggshells in areas where fluorosis is endemic need to be studied. Clinical trials registration: NCT03355222 Keywords: Calcium; Fluoride; Fluorosis; Eggshell powder; Safety; Acceptibility; Women; Ethiopia; Rift Valley.
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    FACTORS ASSOCIATED WITH DIETARY PRACTICE AND NUTRITIONAL STATUS AMONG PREGNANT WOMEN ATTENDING ANC AT MAALIE WOREDA, SOUTH OMO ZONE, ETHIOPIA: FACILITY BASED CROSS SECTIONAL STUDY.
    (Hawassa University, 2024-05) WONDU BERRA
    Background: Maternal dietary practices during pregnancy play an important role. Hence, this study was intended to assess factors associated with the dietary practice and nutritional status of pregnant women in Maalie Woreda, South Omo zone, Ethiopia. Methods: Facility based cross-sectional study design was conducted among 318 pregnant women had participated. Socio demographic and socio economic data were collected using a structured interviewer-administered questionnaire. The dietary practice was measured using 16 dietary practice questions. Dietary diversity was obtained by using a 24-hr dietary recall method and Nutritional status was assessed by using mid-upper arm circumference (MUAC) measurements. Binary and multiple logistic regression analysis were conducted. Variables with P ≤ 0.2 in bivariate analysis were entered for multiple logistic regressions. At a 95% confidence interval, variable with < 0.05 in multiple logistic regression analysis was considered statistically significantly associated with dietary practice and Nutritional status. Result: About 68.6% of the pregnant women had poor dietary practice and 34.3% were undernourished. Educational status (AOR=4.6; 95% CI: 1.50, 11.51), family income (AOR=2.61; 95% CI: 1.35, 6.43), family size (AOR=2.30; 95% CI: 1.10, 2.87), ANC visits (AOR=2.49, 95% CI: 1.09, 4.03), nutrition counseling (AOR=1.81; 95% CI: 1.12, 5.46) and Knowledge (AOR=1.28; 95% CI: 1.13, 4.19) were significantly associated with dietary practice. Husband occupation (AOR=3.29; 95% CI: 1.79, 71.2), cash decision maker (AOR=2.27; 95% CI: 1.14, 3.92), nutrition counseling (AOR=1.73; 95% CI: 1.42, 7.26), Source of nutrition information (AOR=1.51; 95% CI: 1.07 , 8.3), Dietary practice (AOR=1.87; 95% CI: 1.21, 3.51), and knowledge (AOR=1.92; 95% CI: 1.05, 3.06) were significantly associated with nutritional status. Conclusion: The prevalence of good dietary practice during pregnancy was 31.4% and 34.3% were undernourished. Educational status, family income, family size, number of pregnancy, ANC visits, nutrition counseling, Diversity of diet and Knowledge which were significantly associated with dietary practice. Government, health extension workers and responsible stakeholders should focus on pregnant women to have ANC follow-up.
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    ANTI-RETROVIRAL REGIMEN CHANGE AND ITS PREDICTORS AMONG PEOPLE LIVING WITH HIV AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, SOUTHERN ETHIOPIA
    (Hawassa University, 2024-05) WONAGO PETROS
    Background: Anti-retroviral regimen change is among the major challenges for the success of treatment among people living with human immunodeficiency virus (PLHIV), affecting its sustainability and outcome among ART patients. Yet, the evidence on the incidence and predictors of regimen change is unknown in this setting and the region. Objective: The aim of this study was to determine the incidence of antiretroviral regimen change and its predictors among PLHIV at Hawassa University Comprehensive Specialized Hospital in 2024 Methods: An institutional-based retrospective cohort study was conducted among PLHIV who started ART from January 1, 2006, to December 31, 2023. Regimen change was defined as changing the ART regimen due to adverse events. Records were reviewed and standard data extraction form was used to collect data on a kobo tool kit. A Kaplan-Meier plot with a log-rank test at p<0.05 was used to estimate the median follow-up time and compare survival between the covariates. Bi-variable cox-regression analysis was done and variables with p≤0.25 were entered into the multivariable cox-regression model. Predictors with p values<0.05 reported with their adjusted hazard ratios and the 95% confidence intervals. Results: A total of 3856 patients were followed for 39,350 person-years of observation with the median follow-up period of 11.2 years. The incidence rate of anti-retroviral regimen change was 12.1 (95% confidence interval (CI): 11.5–12.7) per 100 person-years. Female gender (Adjusted hazard ratio (AHR) = 2.9, 95%CI = 2.6–3.4), occurrence of TB (AHR = 4.6, 95%CI = 2.9–7.4), occurrence of side effects (AHR = 3.4, 95%CI = 2.9–3.8), baseline CD4 count below 100 cells/mm3 (AHR = 1.3, 95%CI = 1.1–1.6) and availability of social support (AHR = 0.47, 95%CI = 0.38–0.58) were the predictors of regimen change among PLHIV receiving anti-retroviral therapy. Conclusion and recommendation: The incidence of regimen change in this study was comparable to other findings. A number of variables predicted regimen change and female gender, occurrence of drug side effects, occurrence of TB, CD4 below 100cells/mm3 and availability of social support were predictors of incidence of regimen change. Clinicians are recommended to early assess the adverse effects, TB, immunologic failure and strengthen social support to reduce the risk of regimen change among PLIHV.
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    INCIDENCE AND PREDICTORS OF NON-COMMUNICABLE DISEASE AMONG ADULT HIV-POSITIVE PATIENTS AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL
    (Hawassa University, 2024-05) TSION TESFAYE
    Background: Due to the extended life expectancy of HIV/AIDS patients with the availability of antiretroviral therapy, concerns have risen regarding the co-occurrence of HIV and non communicable diseases (NCDs). Thus, this study aims to contribute to scientific knowledge on NCDs among people living with HIV (PLHIV) aged 18 and above at Hawassa Comprehensive and Specialized Hospital. Objective: To determine the incidence and predictors of non-communicable diseases among adult HIV-positive patients at Hawassa University Comprehensive Specialized Hospital 2024. Methods: A retrospective cohort study was conducted from April 1–30, 2024. All HIV-positive patients who fulfilled the eligible criteria and had been followed up at Hawassa University Comprehensive Specialized Hospital from 2003-2022 were considered the total sample size for this particular study. Data was collected from medical records using a standardized checklist using the Kobo toolbox. Statistical Package for Social Studies version 26.0 was used for data analysis. Kaplan-Meier survival function was used to estimate NCDs' free survival time and to compare NCDs' free survival time with a log-rank test. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of NCDs. Adjusted hazard ratio (AHR), P-value <0.05, and 95% confidence interval (CI) were used to report the result. Result: The incidence rate was 8.5 per 100 PYs. Those with a family size >=4 (AHR = 0.6, 95% CI0.4-0.9) Other occupational status (student, prisoner, commercial sex worker )(AHR = 0.4, 95% CI: (0.3-0.7), BMI >=25 (AHR = 2.2, CI: 1.3-3.7), and poor ART adherence (AHR = 3.3, CI: (2-5.5) were predictors for time to any one of the non-communicable disease development. Conclusion and Recommendation: Given the overall incidence of any one of the NCDs, was high, policymakers need to focus on screening and treatment strategies for PLHIV, while healthcare providers need to offer counseling on drug adherence, lifestyle, and diet.
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    PREVALENCE AND FACTORS ASSOCIATED WITH ADVERSE NEONATAL OUTCOMES AMONG CESAREAN DELIVERIES AT PUBLIC HOSPITALS IN HAWASSA CITY, SIDAMA REGION, ETHIOPIA
    (Hawassa University, 2024-06) TAMIRU RIKIBA
    Background: Cesarean deliveries are linked to higher risks of adverse neonatal outcomes compared to spontaneous vaginal births. In Ethiopia, comprehensive data on these outcomes and associated factors is lacking. Understanding these issues in hospitals is crucial for improving maternal and neonatal care. Objective: This study aimed to assess prevalence and factors associated with adverse neonatal outcomes among cesarean deliveries at public hospitals in Hawassa city, Sidama region, Ethiopia. Method and material: a facility based retrospective cross-sectional study was conducted at two public hospitals in Hawassa city from April 1 to 30, 2024, analyzing 522 hospital medical records of mothers who delivered by CS from Jan 2023 to Aug 2024. Data were collected using a structured data extraction checklist via kobocollect 4.0, and Simple random sampling technique was employed to select study participants. Data were analyzed using SPSS version 27, employing Binary and Multiple Logistic regressions to identify factors associated with adverse neonatal outcomes. Statistical significance was stated at p-value<0.05, with adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Result: nearly one-third of newborns delivered through cesarean section developed adverse outcome. Women who had preeclampsia and abruptio-placenta were 2.9 (AOR: 2.9; 95% CI; 1.104, 3.38 and 3.3 times (AOR: 3.3; 95% CI; 1.36, 8.21) more likely to develop an adverse neonatal outcomes compared with those women who did not have the condition respectively. Similarly women who delivered by midline cesarean section were 2.9 times (AOR: 2.9; 95% CI; 1.125, 7.4) more likely to develop adverse neonatal outcomes compared with those women who delivered by lower transverse cesarean section. Women who referred from other facility were 2.8 times (AOR: 2.8; 95% CI; 1.82, 4.4) more likely to develop adverse neonatal outcomes compared with those women who were not referred. Conclusion: prevalence of adverse neonatal outcomes was high in the study area. Preeclampsia, abruptio-placenta, being referred from other health facility, and delivery via midline cesarean section were factors associated with adverse neonatal outcomes. Timely intervention for high-risk pregnancies could help reduce adverse neonatal outcomes.
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    DISRESPECTFUL AND ABUSIVE MATERNITY CARE DURING CHILDBIRTH AND ASSOCIATED FACTORS AT PUBLIC HEALTH FACILITIES IN SHASHEMENE TOWN, SOUTHERN ETHIOPIA
    (Hawassa University, 2024-06) MITIKU DEJENU
    Background: Disrespect and abuse during childbirth in healthcare facilities is a global public health issue that negatively impacts the utilization of skilled birth services. In Ethiopia, despite policies promoting equitable maternal care, there is a high prevalence of disrespect and abuse, which deters women from accessing healthcare facilities. There is a notable research gap, with limited mixed-method studies providing a comprehensive understanding of the issue. Objective: To assess the magnitude and associated factors of disrespectful and abusive maternity care during childbirth at public health facilities in Shashemene Town, Southern Ethiopia, 2024. Methods: A facility-based cross-sectional study using both quantitative and qualitative methods was conducted. The study included 383 mothers, selected through systematic sampling, who gave birth at selected public facilities. Quantitative data were collected using structured questionnaires administered via interviews, while qualitative data were gathered through in depth and key informant interviews with mothers and healthcare providers. Quantitative data were analyzed using SPSS, with descriptive statistics determining the extent of disrespect and abuse. Bivariable and multivariable logistic regression identified associated factors, with a p value less than 0.05 considered significant. Thematic analysis was used for qualitative data. Result: The study found that 68.1% of mothers experienced disrespectful and abusive maternity care. Common forms included non-consented care (68.1%), non-dignified care (63.2%), non confidential care (55.9%), and physical abuse (32.6%). Factors significantly associated with increased odds of experiencing disrespect and abuse included having no formal education [AOR=3.73, 95% CI: 1.93-12.79], primary education [AOR=2.28, 95% CI: 1.08-4.81], residing in rural areas [AOR=2.20, 95% CI: 1.20-4.02], nighttime delivery [AOR=2.89, 95% CI: 1.75 4.76], prolonged facility stays [AOR=2.21, 95% CI: 1.34-3.66], and poor knowledge of mothers [AOR=2.03, 95% CI: 1.20-3.45]. Qualitative findings indicated that lack of resources, high workloads and inadequate training contributed to such behaviors by healthcare providers. Conclusion: Disrespectful and abusive maternity care is highly prevalent in Shashemene Town, with various forms of mistreatment experienced by women during childbirth. Addressing systemic issues through resource allocation, training, and enhanced support mechanisms for healthcare workers and mothers is essential for promoting respectful and high-quality maternity care services.
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    DETERMINANTS OF DELAY IN TREATMENT SEEKING FOR DIARRHEAL DISEASES AMONG MOTHERS WITH UNDER-FIVE CHILDREN IN PUBLIC HOSPITALS OF SIDAMA REGION ,SOUTHERN ETHIOPIA: UNMATCHED CASE CONTROL STUDY
    (Hawassa University, 2024-05) MENELIK MATHEWOS
    Background-.A significant majority of pediatric diarrheal deaths are caused by delays in receiving timely, appropriate care. Life-threatening consequences are decreased when under five children with diarrhea obtain medical attention promptly and appropriately. Therefore, this study looked into factors that contributed to mothers of children under five delaying of treatment for diarrheal illnesses. Objective – To assess determinant of delay in treatment seeking for diarrheal disease among mothers with under five children in public hospitals in Sidama region, southern, Ethiopia from April 1 to May 30,2024 Methods - A Facility-based unmatched case control study was conducted on 414(207 Cases and 207 Controls). Cases were under-five children paired with their mothers/caregivers who sought treatment after 24 hours of the onset of signs and symptoms of diarrheal diseases, and controls were under-five children paired with their mothers/caregivers who sought treatment within 24 hours of the onset of signs and symptoms of diarrheal diseases. Data were collected using KOBO collect with smart Phone and analyzed by using SPSS 26. Bivariate and multivariable logistic regressions were computed to identify independent determinants of delay in treatment seeking. Association was described using an adjusted odds ratio along with their 95% confidence interval. Significance was declared at p<0.05 in the multivariable logistic regression. Results- from 418 selected participants, 414 mothers (207 cases and 207 controls) were included. Being rural resident (AOR 3.40(95 % CI 2.03-5.72), Child age < 24 months (AOR 4.43(95 % CI=2.35-8.34), Mothers without formal education (AOR 11.679(95 % CI 3.705 36.81), difficult to pay cost of treatment (AOR 4.345(95 % CI 2.019-9.352), Absence of health insurance AOR 3.182(95 % CI 1.945-5.207), were significant determinants of delayed treatment seeking. Conclusion-Young age of child, rural residence, Educational level of mothers, difficulty to pay Cost of treatment and absence of health insurance were important determinants of delay in treatment seeking. Thus comprehensive strategies that might enhance health facility accessibility crucial to reduce diarrhea related complications
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    DETERMINANTS OF SEVERE ACUTE MALNUTRITION AMONG CHILDREN 6-23 MONTHS OF AGE IN DARA WOREDA PUBLIC HEALTH FACILITIES, SIDAMA REGION, ETHIOPIA: - A CASE CONTROL STUDY
    (Hawassa University, 2024-04) MEKDES SEIFU
    BACKGROUND Severe acute malnutrition remains a major killer of children under five years of age, especially in developing world, including Ethiopia. Identification of the determinants of severe acute malnutrition under the age of two years can significantly reduce the burden of child morbidity and mortality. OBJECTIVE: To assess determinants of severe acute malnutrition among 6-23-month children METHODS: A facility-based unmatched case-control study was conducted on children aged 6 23 months (213 cases and 213 controls) from four health centers in Dara woreda from February 1 to May 1, 2024. Children aged 6–23 months with severe acute malnutrition were cases and those visiting health centers outpatient service without diagnosis of severe acute malnutrition were controls. The study participants were selected using consecutive sampling technique. Data were collected by the Kobo toolbox and were exported to the Statistical Package for Social Sciences computer software program version 25 for analysis. Descriptive statistics and binary logistic regression were done and variables with p-value less than 0.25 were eligible for the final model. A multivariable logistic regression was also performed and statistically significant level was declared at a p-value < 0.05. The odds ratio at 95% CI was used to measure the strength of association between outcome and predictor variables. The result was presented with different texts, graphs, and tables. Result: - The factors associated with severe acute malnutrition were perceived birth weight [AOR= 0.09, 95% CI=0.03-0.29], getting nutritional information [AOR=17.12; 95% CI: 6.18 47.37], introduction of complementary feeding after six months [AOR= 0.40; 95% CI: 0.18 0.89] and dietary diversity score < 5 groups [AOR= 4.62; 95% CI= 2.30-9.47] were significant. Conclusion: In this study, perceived birth weight, nutritional information, initiation of complementary feeding and dietary diversity were significantly associated with severe acute malnutrition. Thus, emphasis should be given to improving infant and young child feeding practices, especially timely initiation of complementary feeding and dietary diversity.
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    PREVALENCE AND FACTORS ASSOCIATED WITH SEXUAL VIOLENCE AMONG FEMALE HOUSEMAIDS ATTENDING EVENING PRIMARY PUBLIC SCHOOLS IN HAWASSA CITY, SIDAMA, ETHIOPIA: A MIXED METHOD STUDY.
    (Hawassa University, 2024-06) MAEREGE HABTNEH
    Introduction: Threats of rape, attempted rape, rape, sexual harassment, and coerced sexual contact are examples of sexual violence. One of the groups of workers most at risk from sexual violence worldwide is the housemaid. Sexual violence against housemaids remains usually concealed as victims cannot report such offences. This study aims to assess prevalence and factor associated with sexual violence among female housemaid attending evening public schools in Hawassa city, Sidama region, Ethiopia. Objectives. This study intended to assess the prevalence and factors associated with sexual violence among housemaids attending evening primary public schools at Hawasa 2024. Method. School-based cross-sectional study complemented with qualitative approach was conducted among 405 housemaids and 13 purposely selected participant. Simple random sampling was used for the quantitative part while purposive sampling was done to select key informants. Data were collected using an interviewer-administered questionnaire by Kobo Collect for quantitative study then exported to SPSS, while key-informant interview using semi structured interview guide was used for the qualitative study. Both bivariable and multivariable logistic regression analysis were done to assess the association between independent and dependent variables. The strength of association was determined using the adjusted odds ratio (AOR) with their corresponding 95 % confidence interval. P-values of <0.05 were used to declare statistical significance. Tables and diagrammatical presentation were used, and mean with standard deviation were used to interpret continuous variables. ATLAS.ti was used for qualitative data analysis. Finally, the finding was explained by triangulating with the quantitative findings in the result. Result: The prevalence of sexual violence among was 67.9% (95% CI: 63%-72%). The odd of sexual violence was higher among housemaids whose agreement were daily (AOR=11.173, 95% CI =1.220, 15.298), there employer drunk alcohol (4.174, 95% CI = 1.851, 9.416), housemaids origin from rural area (AOR= 2.95 (1.56, 5.55), whereas housemaid living with another housemaid in the household were less likely to face sexual violence (AOR=0.429, 95% CI = 0.218, 0.844). Conclusion: There was a high prevalence of sexual violence among housemaids. Types of agreement, origin of the housemaid, and presence of other housemaid and employers alcohol consumption were significantly associated with sexual violence.