Master of Public Health

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End date: 2025

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    QUALITY OF MEDICAL RECORDS IN PUBLIC HOSPITAL OF WOLAYTA ZONE, SOUTH ETHIOPIA: 2023 MIXED STUDY
    (hawassa universty, 2023-11) MUHIDN JEMAL
    Background – Medical record is a multifunctional document that is used to communicate and document critical information about patients’ medical care among health care professionals. Medical record completeness is a key performance indicator that is related with delivery of health care services in the hospital. Medical recording system has faced challenges related with resources and lack of infrastructure in worldwide trend. Studies have indicated that medical record systems are lacking medical record management quality in low income countries. Objective- To asses quality of medical records in public hospital of Wolaita zone, south Ethiopia, 2023 Methods- Institutional based cross-sectional study concurrently with qualitative study using stratified sampling method was conducted from March 1-15, 2023. A purposive criterion sampling method key interview method was used qualitative data. A total of 406 Medical records were reviewed at three public hospitals in Wolaiyta zone. Review of medical records was done using a checklist and key informant interviews of health professionals and medical record staff. The quantitative data were collected kobo toolkits and exported and analyzed by SPSS version 26.0.the qualitative data was collected analyzed manually by thematic analysis. Results. A total of 406 medical records were reviewed during data collection period of medical records of three public hospitals, with 100% retrieval rate. In the assessment of quality of medical record, clinical components were lowered (76%) compared to Administrative components (87%).Majority of the respondents said that|“… Since lack of regular monitoring and evaluation process, there was problem in quality of medical records in the hospital According to the expected national standard, the study also showed that average quality of medical records of the study area was 68%. Records tertiary hospitals were 44.5% less likely to be quality record as compared to records in primary hospitals Conclusion: The majority of medical records had poor completeness of administrative data, clinical, financial, and legal contents. The overall quality of medical records in Wolaita Zone was very low for components of the quality of medical records as per the standard of hospital requirements.
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    Willingness to Renew Community Based Health Insurance Membership and Associated Factors in Maraka woreda, Dawuro zone, South-west Regional State, Ethiopia
    (hawassa universty, 2023-11) Mikiyas Zelalem
    Background: Although potential instrument to achieve Universal Health Coverage, Community Based Health Insurance schemes commonly suffer from low membership renewal, which threatens the schemes’ sustainability in many developing countries. Hence, this study investigated the willingness to renew Community Based Health Insurance membership and associated factors among enrolled households in Maraka woreda, Dawuro zone. Objective: To assess willingness to renew Community Based Health Insurance membership and associated factors in Maraka woreda, Dawuro zone. Methodology: Community based cross-sectional mixed methods design with sequential explanatory qualitative methods was employed. Using multi-stage random sampling, 5 kebeles were included in the study, from which 693 enrolled households were selected through systematic random sampling (k=5). Descriptive, bivariate, and multivariate logistic regression analyses of data was done using SPSS version 25 software, with statistical significance considered at P-value <0.05. Qualitative data were collected through focus group discussions and key informant interviews, with samples selected using maximum-variation methods. The obtained data were coded and thematically analyzed using ATLAS.ti 9 software. Results: Willingness to renew Community Based Health Insurance membership was shown to be 79.1%. Presence of chronic illness (AOR = 0.30; CI: 0.18-0.52), proportion of household members with poor self-rated health status (AOR = 2.01; CI: 1.04-3.72), recent hospitalization history (AOR = 0.2; CI: 0.11-0.35), perceived availability of medications (AOR = 2.52; CI: 1.48-4.29), premium affordability (AOR = 2.2, CI: 1.26-4.79), perceived benefit packages adequacy (AOR = 2.90; CI: 1.76-4.79), enrollment duration (AOR = 4.01; CI: 2.12-7.56), and participation in scheme related meetings (AOR = 2.40; CI: 1.27-4.58) were predictors shown to be significantly associated with members’ willingness to renew membership. Conclusion: Magnitude of willingness to renew Community Based Health Insurance membership in the woreda was shown to be relatively lower than the woreda’s renewal target for 2016 E.C. Therefore, increased scheme transparency and community engagement, along with policy interventions involving differential premium pricing based on ability to pay and upgrading of the current scheme design to a larger regional or federal pool are recommended to increase members’ desire to renew membership.
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    MAGNITUDE OF URBAN MALARIA AND ITS ASSOCIATED RISK FACTORS IN DAMBOYA TOWN, KEMBATA ZONE, CENTRAL ETHIOPIA
    (hawassa universty, 2023-11) BIRUK MULACHEW GELESHO
    Background: In Africa, urban malaria is emerging as a potential Health problem. Because of the rapidly growing number of towns in Ethiopia, there is a persistent need to improve the understanding of the epidemiology of urban malaria. Objective: This study aimed to determine the prevalence of urban malaria and its associated risk factors in Damboya town Kambata Zone, Central Ethiopia region. Methods: A Community-based cross-sectional study was carried out in Damboya town from March 7 to May 29, 2023. A total of 422 individuals were randomly selected and a structured questionnaire was employed to collect socio-demographic data and malaria-associated risk factors. Finger/ heel prick blood was used to detect malaria parasites by light microscopy and malaria rapid diagnostic test. Data were entered in Epi data 3.1 and analyzed in SPSS version 25 software. The association between dependent and independent variables was explored by using binary logistic regression analyses. An adjusted odds ratio with a 95% confidence interval was calculated and the association was declared at a P-value of <0.05. Result: The overall prevalence of malaria was 5% (95%CI:3.1-7.5) with the predominant P. vivax infections accounting for 61.9%. The presence of stagnant water (AOR=3.88, 95% CI: 1.14-13.22, P=0.030), unavailability of insecticide-treated bed net (AOR=3.24, 95% CI: 1.01 10.41, P=0.048), living in a house with eaves (AOR=4.22, 95%CI: 1.17-15.00, p=0.027), were more significantly associated with malaria prevalence. Conclusion: Malaria is still a public health problem in Damboya town. Thus, improved access to all malaria interventions is needed to interrupt the transmission in the community of this town.
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    LEVEL OF PATIENT SATISFACTION AND ASSOCIATED FACTORS AMONG PRIVATE WING PATIENTS OF WOLAITA SODO UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, WOLAITA, ETHIOPIA: A HEALTH FACILITY-BASED CONVERGENT PARALLEL MIXED STUDY
    (hawassa universty, 2023-11) BINYAM DANIEL
    Background: To improve the quality of health care given in the private wing, the health care provider needs to know what factors influence patient satisfaction. Although few studies have been conducted on patient satisfaction in private-wing health services it was never been done in this study area. Objective: To assess the level of Patient Satisfaction and associated factors among Private wing patients of Wolaita Sodo University Comprehensive and Specialized Hospital, Wolaita, Ethiopia 2023 G.C Methods: A health facility-based convergent parallel mixed study was conducted. A Systematic random sampling technique was used to select 300 patients. Data was collected by the ODK collect app and was then imported to SPSS version 25 for analysis. The views of 7 qualitative participants selected conveniently until data saturation were explored using in-depth interview. Frequency distribution of variables was tabulated. Bivariate and multivariable logistic regressions were fitted to identify the factors that determine patient satisfaction. Qualitative data analysis used a thematic analysis technique which was supported by ATLAS.ti 7.5.16 data management software. Result: A total of 300 patients were included in the study and 260 (86.7%) (95% CI= 82.3-90.3) of the patients were satisfied with the service they had gotten. Age between 18-34 (AOR= 0.26, 95% CI= 0.17-0.36), doctors explain medical terms (AOR= 3.50, 95%CI= 1.21-10.07), pharmacist explains about the medication (AOR= 3.16, 95%CI= 1.06-9.41) were significantly associated with patient satisfaction. Similarly, the lack of drugs and supplies in the hospital pharmacies and laboratory, and the unavailability of private toilets and showers were also major problems that led to less satisfaction with the overall private wing services. Conclusion and recommendation: In conclusion, the net overall level of satisfaction was high. Regarding this study, significant predictors of patient satisfaction were age, doctors explain medical terms, and pharmacists explains about the medication. Making all the essential laboratory investigations, drugs, and standard medical equipment available in the hospital along with toilets and showers available in every private room is important to improve patient satisfaction in the private wing setting
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    VACCINE COLD CHAIN MANAGEMENT PRACTICE AND ITS ASSOCIATED FACTORS IN PUBLIC HEALTH INSTITUTIONS OF WEST ARSI ZONE, OROMIA, ETHIOPIA, 2023
    (hawassa universty, 2023-11) ABDO HAJO JARSO
    Background: In spite of high immunization coverage still there is high range of child mortality due to vaccine preventable diseases (VPDs).This problem is attributed to reduced vaccine potency resulted because of failure in cold chain management system which is less considered in developing countries including Ethiopia, particularly in this study area. Objective: The aim of this study was to assess vaccine cold chain management practice and its associated factors in public health institutions of west Arsi zone, Oromia, Ethiopia 2023. Methods: A facility-based cross-sectional study was conducted in all health institutions of randomly selected woredas in the west Arsi zone. A structured self-administered questionnaire and on-spot observation checklists were used to collect data from the healthcare facilities. Epi-data version 4.6.0.6 was used for data entry and Statistical Package for Social Sciences (SPSS) version 26 was used for analysis. The bivariate and multiple logistic regression analyses were conducted. Adjusted odd ratio (AOR) with a 95% confidence interval (CI) was used to determine the strength of association and the level of significance was set at P-value < 0.05. Result: In this study, more than half (54.1%) of the public health institutions had good vaccine cold chain management practices. Good knowledge of vaccine handlers Adjusted Odds Ratio( AOR) (95% Confidence Interval(CI) = 3.85(1.32-11.25), regular supportive supervision AOR (95% CI)= 4.81(1.60-14.4), availability of Expanded program of immunization (EPI) guideline in healthcare facilities AOR (95% CI)= 5.21(1.67-16.3), no workloads AOR (95% CI)= 3.20(1.06-9.71) and using of vaccine request format AOR (95% CI)= 3.67(1.21-11.10) were positively associated with good vaccine cold chain management practice. Conclusion: Vaccine handlers working in the study area of public health facilities had poor vaccine cold chain management practice. Enhancing the knowledge of vaccine handlers, providing guidelines, vaccine request forms, supportive supervision, and monitoring their practice toward cold chain management may help to improve practice towards vaccine cold chain management.
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    MAGNITUDE OF HEALTH-RELATED QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG ADULT DIABETES MELLITUS PATIENTS IN PUBLIC GENERAL HOSPITALS OF SIDAMA REGION, ETHIOPIA
    (hawassa universty, 2023-11) AHMED BEDRU
    Background: Diabetes mellitus is a chronic disease with considerable impact on health status and quality of life. Health-related quality of life (HRQOL) is a multifaceted concept that is strongly impacted by diabetes in developing countries. Objective: This study aimed to assess the magnitude of health-related quality of life and associated factors among adult diabetic patients attending public general hospitals in Sidama Region, Ethiopia, 2023. Methods: An institutional-based cross-sectional study design was applied on systematically selected 417 adult diabetic patients in public general hospitals in the Sidama region from June 16 to July 15, 2023. HRQOL was evaluated using the World Health Organization Quality of Life Brief Version questionnaire. Binary logistic regression analysis was used to see the association between dependent and independent variables. Candidates for multivariable analysis were variables with p < 0.25 in the bivariable analysis, and p < 0.05 with a 95% confidence interval was considered to declare a statistically significant association. Results: Of the 417 study participants, 48.4% had a good HRQOL. Factors significantly associated with good HRQOL were age between 29 and 39 years [AOR = 2.54 (95% CI, 1.24 5.20)], marital status being married [AOR = 5.2 (95% CI, 1.80-14.97)], college and above education [AOR = 5.48 (95% CI, 1.41-21.33)], occupation being student [AOR = 5.47 (95% CI, 1.19-25.19)], community based health insurance utilization [AOR = 3.18 (95% CI, 1.55-6.53)], doing physical exercise [AOR = 4.25 (95% CI, 2.37-7.61)], duration of illness more than 59 months [AOR = 6.79 (95% CI, 3.28-14.05)], insulin only treatment modality [AOR = 2.46 (95% CI, 1.01-6.04)], absence of DM-related complications [AOR = 3.52 (95% CI, 1.57-7.89)]. Conclusion: Nearly half of the study participants had a good health-related quality of life. Except age, all associated factors identified in this study are modifiable if appropriate measures or strategies are provided and implemented accordingly
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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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    PELVIC ORGAN PROLAPSE AMONG WOMEN IN SIDAMA REGION, ETHIOPIA: PREVALENCE, RISK FACTORS, AND EFFECT OF PELVIC FLOOR MUSCLE TRAINING
    (Hawassa University, 2025-04) MELESE SIYOUM DESTA
    Background: Pelvic organ prolapse (POP) is a condition characterized by the descent of pelvic vaginal compartment and the surrounding organs. It’s impact on a woman's quality of life can be substantial, resulting in psychological distress, social isolation, and physical complications. POP is a prevalent condition affecting millions of women worldwide. Despite its widespread occurrence, the true prevalence remains uncertain due to inconsistencies in diagnostic methods and reporting practices. Pelvic floor muscle training is a recommended first-line treatment for managing POP, but its effectiveness in low-income setting is understudied. Objectives This study aimed to enhance the understanding of pelvic organ prolapse symptom assessment, its prevalence and risk factors, and the management of mild to moderate pelvic organ prolapse among women in the Sidama Region, Ethiopia. Methods A total of 100 women with symptomatic prolapse completed the POP-SS questionnaire during the first round of interviews, with 61 completing a second round for test-retest reliability assessment. Content validity was evaluated using the content validity index and the construct validity was assessed through exploratory factor analysis. Known group validity was determined using the Kruskal-Wallis test. Internal consistency reliability was assessed using Cronbach's alpha, and test retest reliability was evaluated using the intraclass correlation coefficient to assess the stability of the questionnaire over time (Paper I). A community-based cross-sectional survey was conducted in the Dale-Wonsho Health and Demographic Surveillance Site from March to October 2023. A multi-stage stratified cluster sampling method was employed to select a representative sample of 816 women. Anatomical prolapse was diagnosed using the standardized pelvic organ prolapse quantification (POP-Q) method. Symptomatic prolapse was assessed through patient-reported symptoms, allowing for the identification of women experiencing significant discomfort or functional impairment. A complex survey-based modified Poisson regression was used to identify risk factors associated with prolapse (Paper II).Furthermore, a parallel-groups, two-arm cRCT was conducted in the Dale-Wonsho Health and Demographic Surveillance Site. A total of 187 women with symptomatic POP stages I-III from eight kebeles/clusters were randomized by cluster to receive either midwife-led pelvic floor muscle training plus lifestyle counselling (intervention group) or lifestyle counselling alone (control group). The primary outcomes included changes in prolapse symptom score (POP-SS) and prolapse quality of life (P-QoL). Mixed-effects generalized linear models were utilized to determine the effect of pelvic floor muscle training on prolapse symptoms and prolapse quality of life (Paper III). Results The pelvic organ prolapses symptom score questionnaire was successfully translated into Sidaamu Afoo, demonstrating good content validity (0.88) and high internal consistency (α= 0.79). Test retest reliability was also strong (ICC = 0.83). Exploratory factor analysis revealed two factors (physical and functional) explaining 70.6% of the variance, with significant loadings for each item. Known group validity showed a significant difference in median prolapse symptom scores across different prolapse stages (Kruskal-Wallis χ2 = 17.5, p < 0.001) (Paper I). In Paper II, among the 815 women surveyed, 779 (95.6%) underwent pelvic examinations. Anatomical prolapse (stages II-IV) was observed in 241 (30.90%, 95%CI: 24–38.7%) participants, The overall prevalence of symptomatic prolapse in the total sample was 189 (24.27%, (95% CI: 19.98–29.16%). Significant risk factors for anatomical prolapse included higher parity (APR: 1.17; 95%CI: 1.1-1.24), prolonged heavy lifting (APR: 1.26; (95%CI: 1.14-1.4), and prolonged labor (APR: 1.32; 95%CI: 1.1-1.56). Factors associated with symptomatic prolapse included early childbirth (APR for age at first birth < 18 years: 1.29 (95%CI: 1.1-1.52) and prolonged heavy lifting (APR: 1.16 (95%CI: 1.10-1.28). In the intervention study (Paper III), 187 women were randomized to the intervention (n=86) and control (n=101) groups. At six months, the intervention group showed significantly greater improvements in prolapse symptoms compared to the control group, with a mean change difference of -4.11 (99% CI: -5.38, -2.83). Significant improvements were also observed in the intervention group across various domains of the prolapse quality of life scale: -8.86 (99% CI: 13.84 -3.89) in physical domain; -11.18 (99% CI: -15.03, -7.32) in psychological domain, and 9.01 (99% CI: -10.49 -5.54) in personal relationship domain. A higher proportion (83.72%) of women in the intervention group perceived their condition as "better" after the intervention, compared to 41.57% in the control group. Conclusions The Sidaamu Afoo version of the POP-SS tool is valid and reliable for assessing pelvic organ prolapse symptoms. The prevalence of anatomical and symptomatic prolapse is notably high in the Sidama Region, with identified risk factors necessitating community-based education and interventions. Moreover, midwife-led PFMT combined with lifestyle counselling significantly improves symptoms and quality of life in women with mild to moderate POP, highlighting its potential for integration into maternal and reproductive health programs in low-resource settings. In addition, routine screening and campaigns are needed to identify the cases early.
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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.