College of Medicine and Health Science

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A research paper to be submitted to Hawassa University College of Medicine and Health Science School of Public Health in Partial Fulfillment of the Requirement for Degree of Masters in Public Health in Reproductive Health
(hawassa universty, 2023-11) Simegn Anbese
Background: Vaginal birth after cesarean (VBAC) is giving birth through vagina after giving birth previously by cesarean section. Repeated caesarean deliveries associated with maternal and child complication. It had expanded hospital duration, and high risk of postpartum hemorrhage. However vaginal birth after cesarean is the best choice to reduce repeated CS. But there was insufficiency of evidence to predict determinants of successful vaginal birth after cesarean. So the aim of this study to identify determinants of successful vaginal birth after cesarean section to decreases the overall CS rate and related complication. Objective: To identify determinants of successful vaginal delivery after Caesarean Section at Public hospital in Hawassa city, Sidama Region, Ethiopia, 2023. Methodology: A facility based un-matched case control study was conducted at public hospitals in Hawassa city, Sidama region. A total of 107 consecutive cases and 214 controls were included. Data were collected using pre-tested interviewer administered questionnaire and chart reviewing. Then the data were exported to SPSS for analysis. Descriptive statistics analysis was done. A bi variable regression analysis was done for all independent variables .Variables with p values < 0.25 in bi variable analysis were taken and analyses in multivariable logistic regression .Finally the multivariable logistic regression model were considered statistically significant p values of <0.05 with corresponding 95% CI. Result: In this study 321 mothers were participated from those 107 give birth through birth canal after trial of lobour and 214 mothers end the labour with repeated CS. Mothers who have counseling about trial of labour during Anti natal follow up (AOR2.808; 95%CI1.543-5.112) ,mother who have history of successful vaginal birth after cesarean section(AOR4.170; 95%CI 2.317-7.504), membrane ruptured on admission (AOR 4.891; 95%CI 2.728-8.771) and BISHOPE score >6(AOR 2.661; 95%CI 1.415-4.881) significantly associated with successful VBAC. Conclusion Successful VBAC is reduced repeated cesarean delivery and related complication. So in our study counseling about TOLAC during ANC follow up, History of successful VBAC, Membrane ruptured on admission and BISHOPE score >6 were determinants of successful VBAC
ACCEPTANCE OF CESAREAN SECTION AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN ATTENDING ANTE NATAL CARE AT PUBLIC HEALTHG PUBLIC HEALTH INSTITUTIONS, SIDAMA REGION, HAWASSA CITY. 2023
(hawassa universty, 2023-11) Sifen Ahmed
Background: Cesarean Section (CS) is surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is one of the most common surgeries worldwide, accounting for more than 1 in 5 (21%) of all births. Acceptance of cesarean is the agreement with or being belief in cesarean section or it is the act of consenting to it. Although efforts are being made to minimize the CS rate, some women may refuse to accept it if the necessity arises due to a lack of awareness and a bad attitude toward CS. Even if they there were so many who had accepted cesarean section, some women showed total aversion to cesarean section, whatever the indication was. Therefore, the objective of this study was to assess the acceptance of cesarean se ction and associated factors among pregnant women attending ante natal care at public health institutions in Hawassa city. Methods: Institutional based cross-sectional study was employed among pregnant women attending ante natal care at selected Public Health Institutions in Hawassa city from July 24 to August 25, 2023. Systematic sampling technique was applied to select 422 participants. Kobo Toolbox used to collect data and was exported to Statistical Package for Social Sciences (SPSS) version 25software. Bivariate and multivariate logistic regression analyses were applied to assess associations between dependent and independent variables. The odds ratio with a 95% confidence interval used to declare the strength of associations between dependent and independent variables. P values less than 0.05 was considered statistically significant. Results: Finding of this study showed that acceptance of cesarean section among pregnant women was 50.2%. Respondents educational level AOR=6.5, 95% CI (1.5-25), Previous history of cesarean section AOR=7.19, 95%CI (1.94 27.5), place of delivery for the previous delivery AOR=4.15, 95% CI (1.01-11.6) and knowledge of respondents AOR=2.23, 95% CI (1.23-4.14) have showed significant association with acceptance of cesarean section. Conclusion This study showed about half of the respondents accepted a cesarean section. Educational status of women, previous history of cesarean section, place of delivery for the last previous birth, and respondents knowledge of cesarean section were predictor variables for the acceptance of cesarean section.
ADMISSION OUTCOMES AND ASSOCIATED FACTORS OF ADULTS ADMITTED TO INTENSIVE CARE UNITS OF SELECTED GOVERNMENTAL HOSPITALS IN SIDAMA REGION, ETHIOPIA, 2023
(hawassa universty, 2023-11) BIRHANU MULETA BAYECHA
Background: Intensive care ismultidisciplinary and inter-professional specialty dedicated to the total management of patients with acute life-threatening conditions. Patientsadmitted to the intensive care unit need frequent assessments of their vital signs, invasive hemodynamic monitoring, intravenous drugs and fluid management, ventilatory assistance, and dietary support. The overall goal is to increase the patient chance of survival.In resource-limited settings, mortality is still higher due to various reasons. Objective:To assess admissionoutcomes, andassociated factors of adults admitted to intensive care units of selected governmental hospitals in theSidama region, Ethiopia, 2023. Materials and methods: After obtaining ethical clearance,a cross-sectional study was conducted on 401adult patients admitted to ICUfromMarch 2020 to February 2023. Patient‘s chart was selected by systematic randomsampling; needed information was retrieved by a pretested data abstraction tool and analyzed with SPSS version 26.Furthermore,to support this study ICU director and/or chief nurse were surveyed regarding ICU characteristics.A binary and multivariable logistic regression was conducted to see if variables were associated with outcomes. Results: The emergency department was a common source of admission (65.4%) to the ICUs. Cardiovascular diseases107(27.4%) were common causes of ICU admission.The mortality rate was 39.5%.Patients who were within the 56-65(AOR=3.6, CI,1.130-11.408), and >65 (AOR=4.3,CI,1.125-16.625) age category, mechanically ventilated(AOR=4.3, CI,2.117-8.837), high serum creatinine (AOR=2.4, CI,1.186-4.668), lowsodium(AOR=2.6, CI,1.344-5.188), lowpotassium (AOR=2.1, CI, 1.038-4.097),anemicat admission (AOR= 3.6, CI,1.908-6.636), and supported with a vasopressor (AOR= 6.2, CI, 3.212-12.131)were at higher risk of mortality whereasthose treated in general hospitals (AOR=0.5, CI,0.239 0.950)were at lower risk of mortality. Conclusion and Recommendation: The overall mortality observed in this study was high. ICU to hospital bed ratio should be improved and clinicians should give due attention to patients who had these associated factors of mortality at admission.Overall there is a need to strengthen action to improve critical care services in the region.
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.
ANTIDEPRESSANT-LIKE ACTIVITY OF CRUDE LEAF EXTRACT AND SOLVENT FRACTION OF THE Commelinna benghalensis LINN IN THE RODENTS
(hawassa universty, 2023-11) TEGEGN HALALA
Background: An ethno-botanical study has shown that Commelina benghalensis has been used in the treatment of depression, but its efficacy and safety have not yet been established. Therefore, this study aimed to investigate the antidepressant-like activity of C. benghalensis crude leaf extract and the solvent fraction in rodents. Method: The antidepressant-like activity of the crude leaf extract and solvent fraction of C. benghalensis was evaluated using the depression models of Forced Swim Test (TST), Forced Swim Test (FST), and Open Field Test (OFT). Animals were randomly assigned to five groups. Group I received the vehicle (10 ml/kg), and Group II received the standard drug of fluoxetine (20 mg/kg). The test group from III to V received 100 mg/kg, 200 mg/kg, and 400 mg/kg of the crude extract or solvent fractions of C. benghalensis. The data was statistically analyzed using ANOVA, followed by a post-hoc Tukey test. The results were considered significant at P<0.05, 95% and P<, 0.001, 99% confidence interval. Result: The crude leaf extract of C. benghalensis, at 100 mg/kg doses, did not reduce immobility time in both the TST and FST models. However, at doses of 200 and 400 mg/kg (p<0.05, p<0.001), immobility time was significantly reduced. In TST mice treated with hexane and ethyl acetate fraction at doses of 200 and 400 mg/kg (p<0.05, p<0.001), there was a significant reduction in immobility time compared to the control group. The aqueous fraction at doses of 100, 200 (p<0.05), and 400 mg/kg (p<0.001) shows a significant reduction in immobility time compared to the control groups. The hexane and ethyl acetate fractions significantly reduced immobility duration in FST at 400 mg/kg compared to the control. Rats treated with aqueous fraction at doses of 200 mg/kg (p<0.05) and 400 mg/kg (p<0.001) showed a significant decrease in immobility duration compared to the control group. Conclusion: The study found significant antidepressant-like activity in C. benghalensis crude leaf extract and solvent fraction. As no impact on locomotor activity was observed in the OFT model, the possible mechanism could not be non-specific motor stimulation. Further study on the isolation and identification of bioactive compounds responsible for the antidepressant activity of the extract should be done.
ASSESSMENT OF CALF MORBIDITY AND MORTALITY RATE AND ASSOCIATED RISK FACTORS ON SMALLHOLDER DAIRY FARMS IN SELECTED DISTRICTS OF CENTRAL REGION, ETHIOPIA
(hawassa universty, 2024-05) BIRUK ALEMU BASORE
The dairy sector in Ethiopia is crucial for the agricultural economy by improving smallholder farmers’ livelihood. However, challenges with calf morbidity and mortality hinder the industries development. A longitudinal study was conducted from December 2022 to May 2023, on 204 calves in selected 120 smallholder dairy farms of three districts of central region, Ethiopia. The objectives of the study were to estimate calf morbidity and mortality rate, and to identify predisposing risk factors in the first six months of life. Survival analysis using the Kaplan–Meier (K-M) method, and Cox proportional hazard regression were employed to compute the life-to event data on morbidity and mortality. The total crude morbidity and mortality rates for calves in the study areas were 13 and 4 cases per 100 calf months at risk, respectively. The study revealed that the cumulative incidence of all-cause mortality and all-cause morbidity were 21% and 54%, respectively. Diarrhea was the most commonly diagnosed disease syndrome, leading to 25% morbidity and 14.7% mortality. The morbidity rate in males was 1.86 times higher than female (p<0.05). The calf born from assisted dam during calving had a higher risk of morbidity than calf born from not assisted dam (HR=1.93, p<0.05). The study also revealed that non-concrete farm floors are related significantly to a greater risk of morbidity (HR = 2.88, p<0.05) than concrete floors. The risk of morbidity was decreased by 49%, 53%, 79% and 73% in calves that were fed colostrum, weaned after 90 days, born to local breed dams, and in calves older than 90 days, respectively when other parameters held constant. Likewise, the mortality risk was higher on assisted calving (HR=7.7, p<0.05), on calves born outdoors (HR = 27.3, p<0.05), on early separation of the calf (HR = 7.68, p<0.05), and in non-concrete floor farms (HR=9.18, p<0.05). By holding other model parameters constant, the risk of mortality was decreased by 75%, 77%, 95%, 97%, and 85% in calves that were reared in urban area, consumed colostrum of their dam, got presence of dam during hand feeding, weaned after 90 days of their age, and in calves older than 90 days, respectively. The high rates of calf morbidity and mortality in the current study area pose a significant challenge to dairy sector's development. Hence, enhancing good management practices and conducting further confirmatory investigations are suggested to address and reduce risk factors for calf health problems and mortality.
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.
BEHAVIORAL INTENTION AND ITS ASSOCIATED FACTORS TO USE CERVICAL CANCER SCREENING AMONG WOMEN (30-49) YEARS OLD ATTENDING MATERNAL AND CHILD HEALTH SERVICE IN SHEBEDINO DISTIRICT HEALTH CENTERS, SIDAMA REGIONAL STATE, ETHIOPIA, 2023.
(hawassa universty, 2023-10-10) YOHANNES TEFERA AYANE
Background Cervical cancer is the leading cause of death from cancer in Ethiopian women. Despite numerous interventions, there is a low uptake of cervical cancer screening services. Objective: The aim of this study was to assess the magnitude of behavioral intention and associated factor to use cervical cancer screening services among women who are visiting maternal and child health services in Shebedino district health centers. Method: Institutional based mixed cross-sectional study design used to employ women’s age between 30-49 years old. Systematic random sampling method employed to select participants. Qualitative Data was gathered and analyzed through discussion under major thematic area. linear regressions model was conducted to identify independent predictors of intention on cervical cancer screening among women. Result: Out of 401, 288(71%) of respondents had heard about cervical cancer, however, about 92(23%) of women were knowledgeable about the disease. 120 (29%), 98 (24%), 81 (20.1%), and 42(11%) of the respondents were know the sign & symptoms, risk factors, prevention methods and screening frequency of cervical cancer respectively. The qualitative finding revealed that women did not like to be screened for cervical cancer because they thought that procedure squeeze the cervix and it may result in perforating the uterus that would expose them for infertility. In addition, the qualitative findings supported quantitative results, where the constructs of the theory of planned behavior play an essential role in the improvement of women’s intention. Having knowledge about cervical cancer and past screening practice were positively associated with intention to screen (β = 0.145, CI, 0.001, 0.122), (β = 0.098, CI, 0.093, 1] respectively. Standardized regression coefficient shows; all constructs of the theory were positively and significantly associated with intention to screening. Perceived difficulty or easness (β = 0.297, CI, 0.172, 0.343), perceived social pressure (β = 0.248, CI, 0.131, 0.30) and attitude (β=0.11, CI, 0.018, 0.158).The study showed that magnitude of intention was 198 (44%) of woman had intention to screen for cervical cancers from date of interview. Conclusion: This study showed that women’s intention to screen for cervical cancer was low. Positive attitudes towards cervical cancer screening (CCS), subjective norms, and perceived behavioral control were predictors of women’s intention to screen for cervical cancer. Recommendation: Thus, efforts should be exerted to improve the attitude of women involving influential people, who could improve women’s intention for cervical cancer screening. Moreover; behavioral change communication focuses on the constructs of the theory of planned behavior.
BREAST CANCER SCREENING PRACTICE AND ASSOCIATED FACTORS AMONG FEMALE NURSES WORKING AT SOUTH OMO ZONE PUBLIC HEALTH FACILITIES, SOUTHERN ETHIOPIA, 2023
(hawassa universty, 2023-11) TADELE DAMENA (BSc)
Background: Globally, breast cancer is one of the most prevalent cancers and the leading cause of mortality for women due to not receiving screening. Therefore, early detection of breast cancer could potentially reduce morbidity and mortality from breast cancer among women. Hence, female nurses play a vital role in promoting breast cancer screening, although there is scarce data regarding the screening practices among female nurses in the research area. Objective: To assess breast cancer screening practice and associated factors among female nurses working at South Omo Zone public health facilities in Southern Ethiopia in 2023. Methods: An institutional-based cross-sectional study was conducted from May 15 to June 15, 2023, among female nurses employed in public health facilities in the South Omo Zone. Simple random sampling was used to select the study participants. Data was collected using a pre tested, structured, and self-administered questionnaire. The collected data were entered and cleaned using Epi Data version 3.1 and exported to SPSS version 22 for analysis. Binary logistic regression analyses were used. Variables with a p-value <0.05 in the multivariable logistic regression analysis were considered statistically significant. Result: In the current study, the prevalence of breast cancer screening practice was 21% (95% CI: 16.0, 26.5) based on recommendations. The mean age of respondents is 33 ±7 SD. Being age ≥40 years (AOR = 0.18; 95% CI: 0.04–0.70), having good knowledge about breast cancer signs and symptoms (AOR =2.94; 95% CI: 1.18–7.35), good knowledge of risk factors (AOR =8.60; 95% CI: 3.72–19.87), high perceived susceptibility (AOR = 2.55; 95% CI: 1.11–5.88), and a high perceived benefit of breast cancer screening (AOR = 2.30; 95% CI: 1.02–5.18) were significantly associated. Conclusion and recommendation: The practice of breast cancer screening among female nurses in the study area was low as compared to previous studies. Being age ≥40 years, knowledge of signs and symptoms, risk factors of breast cancer, susceptibility to breast cancer, and benefits from breast cancer screening were associated with the practice of breast cancer screening. It is better to provide mammography and training to improve breast cancer screening.
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.
Clinical outcomes and associated factors of acute poisoning among patients admitted to Hawassa University Comprehensive specialized Hospital, Sidama Regional State, Ethiopia
(Hawassa University, 2024-09) Kindalem Worku
Background: Acute poisoning is a worldwide public health concern as well as a medical emergency that can arise from exposure to high concentrations of any substance that has toxic consequences and manifests within hours of exposure. It’s a common reason for emergency room admission, which leads to mortality and morbidity. Ethiopia is among the countries that don’t have a dedicated toxicology center which is important for treating poison cases. Objective: The purpose of this study was to assess the Clinical outcomes and associated factors of acute poisoning among patients admitted to Hawassa University Comprehensive Specialized Hospital Emergency Department, Hawassa, Ethiopia from December 2018 to December 2023. Methods: It was a retrospective cross-sectional hospital record-based study of acute poisoning cases admitted to HUCSH ED during the study period. The data were collected using a structured questionnaire, entered, coded and cleaned using Kobo data collection toolbox software and exported to SPSS version 25 software. The data were analyzed for descriptive statistics and statistical analysis was performed using bivariate for those variables having a P value of < .25 multivariable logistic regression analysis was done to identify factors associated with the death of acute poisoning cases. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median and percentage. The statistical significance was declared at a P value less than 0.05. Result: In this study, a total of 212 acute poisoning cases were retrospectively analyzed. From the total cases majority of the cases were males accounting for 110 (51.9%). With a median age of 22 years the number of deaths in this study was 20(9.4%) at 95% (CI: 6.15%, 14.20%) and organophosphate being the common agent at 66(31.1%) as well as the common agent ascribed to death. Multivariable logistic regression analysis showed that the independent factors associated with death were hospital stay of more than two days [AOR: 1.009(.00, .18)); p-value of: .002]. Conclusion: Patients with acute poisoning had a high fatality rate in poisoning cases. A longer hospital stay of more than 48 hours, the presence of medical complications after admission and in patients who are more than 26 years old were found to be associated with death.
COMMUNITY-BASED HEALTH INSURANCE MEMBERSHIP DROPOUT RATE AND ASSOCIATED FACTORS IN BORE WOREDA, GUJI ZONE, ETHIOPIA: MIXED STUDY DESIGN
(hawassa universty, 2023-11) YADASA MIRA
Background: The community-based health insurance program in Ethiopia was introduced in 2011, and 48% of homes were enrolled in June 2015. However, 18% of families that had subscribed in the first year stopped in the second year. While still initial enrollment is crucial, a higher dropout rate threatens the sustainability of community-based health insurance. This also has a negative effect on future enrollment and the magnitude of drop-out rates in addition to reducing the size of the insurance pool. However, there is a scarcity of data on household dropout rates of community-based health insurance coverage and related factors in Bore Woreda. Objective: Community-Based Health Insurance Membership Dropout Rate and Associated Factors in Bore Woreda, Guji Zone, Ethiopia, 2023. Method: Community-based cross-sectional study design supplemented by a qualitative method was employed. A total sample size of 502 for the quantitative study, and a purposive sampling for key informants interviewed from scheme officers, kebele managers, health office heads, and health center directors were included. We used a multistage sampling technique to select samples from the Kebeles. Data were entered into SPSS then descriptive analysis and binary logistic regressions were computed. Qualitative data was transcribed and manually analyzed using thematic area analysis. Result: The magnitude of the dropout from CBHIM was 21.1% with a 95% confidence interval (CI): of 17.5%-25.1%. Number of household family size, > six (6) (AOR:0.55, 95% CI: 0.33 - 0.93), annual family income > 25000 (AOR:2.11, 95% CI: 1.26,3.53), the place they usually seek treatment in, private health facility (AOR:0.15, 95% CI: 0.07,0.93) were found to be significantly associated dropout from community-based health insurance. The overall perception towards CBHIM was found to be favorable with 96.6% among the respondents. The theme identified from the qualitative study was “increasing number of new enrollments”, there are dropouts from the scheme. And also “socioeconomic factors like household income and household family size”. The “unavailability of drugs and other medical equipment” was a major complaint for dropping out of the scheme. Conclusion: The findings from the study showed that dropout is high in the area. Annual family income, household family size, and the place they usually seek treatment were found to be associated with dropout from community-based health insurance. The findings from qualitative also showed that there is a dropout of CBHIM in the community and also suggested that sociodemographic factors like income and family size have effects on membership. As a recommendation, we recommend emphasizing more on availing medications as well as other medical equipment and focusing on bettering health care service quality.
DETEMINANTS OF SURGICAL SITE INFECTION FOLLOWING CESAREAN DELIVERIES IN HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, HAWASSA, ETHIOPIA : UNMATCHED CASE –CONTROL STUDY
(hawassa universty, 2023-05) SISAY DEJENE
Background - Globally the incidence of infection following Cesearn delivery was significantly higher in lower-income countries including Ethiopia. Even though surgical site infection is among the leading causes of maternal mortality and morbidity, only a few studies have been conducted on the determinants of surgical site infection following cesarean deliveries. Objective – This study aimed to identify the determinants of surgical site infection following cesarean deliveries in Hawassa University Comprehensive Specialized Hospital Hawassa, Ethiopia. Methods – A hospital-based unmatched case-control study was conducted from September 2019- to September 2022 at Hawassa University Comprehensive Specialized Hospital. Data was extracted from April 15 to May 15, 2023. Cases were selected through consecutive sampling, while controls were selected using a systematic random sampling method. A total of 320 participants were included (107 cases and 213 controls). Data were collected by using the Open Data kit (ODK) downloaded and exported to XLS then imported to SPSS version 26. A binary logistic regression model was conducted and a variable with a p-value of < 0.25 was selected as a candidate variable for the final multivariable logistic regression model and a P-value of less than 0.05 was statistically considered as significant predictors. Results: A total of 320 mothers (107 cases and 213 controls) were included in this study. Women with diabetes mellitus were 3.7 times [AOR: 3.71, 95%CI: 1.18–11.66] at higher odds for surgical site infection compared to women who did not have diabetes mellitus. Vaginal examination [AOR= 2.28 (95%CI, 1.15-4.54)], post-operative hematocrit less than 30% [AOR= 4.12(95% CI 1.97-8.61).women in labour during C/S [AOR= 5.16( (95%CI,1.33-20.1)]. more than 5 days duration of hospital stay[AOR=3.42 (95%CI, 1.32-8.89)] were identified factors. Conclusion and Recommendation ; In this study Diabetes mellitus, Number of vaginal examinations, post-operative hematocrit, labor status during C/S and length of hospital stay were the identified as determinants of surgical site infection following cesarean deliveries. Therefore early detection and risk assessment during certain times in order to reduce these determining factors of surgical site infection is important
DETERMINANTS OF CERVICAL CANCER SCREENING UTILIZATION AMONG WOMEN AGED 30-49 YEARS OLD IN NORTH ARI DISTRICT, ARI ZONE, SOUTHERN ETHIOPIA, 2023.
(hawassa universty, 2023-11) AYALEW BELAYNEH
Background: In Ethiopia, an estimated 7445 women are diagnosed with cervical cancer, and 5338 die from the disease. But early screening has a vital role in reducing morbidity and mortality. However, the utilization of cervical cancer screening is very low in Ethiopia, and there is still no scientific evidence on determinant factors in the study area. OBJECTIVE: To identify determinants of cervical cancer screening utilization among women aged 30-49 years old in the north Ari district, Ari zone, Southern Ethiopia, 2023. METHODS: A community-based unmatched case-control study was conducted among 30-49 year-old women in the north Ari district from April 15/2023 to May 15/2023. A simple random sampling technique was used to select cases and control a total selected women were 219 for the study. A pre-tested, interviewer based, structured questionnaire was used to collect data. Data were entered using Epidata 3.1 and exported to SPSS (Statistical Package for Social Science) version 25 for data analysis. Variables with a p-value of less than 0.25 in the bivariable analysis were included in the multivariable logistic regression, and a final p-value of < 0.05 with a 95% confidence interval for the adjusted odds ratio to determine the level of significance. RESULT: A total 216 women were participated in this study making a response rate of (98.7%). This study showed that no polygamy (AOR 0.23, 95%CI 0.12-0.44) a moderate level of knowledge about cervical cancer (AOR 6.75, 95%CI 1.9, 22.8), a high level of knowledge about cervical cancer (AOR 4.17, 95%CI 1.2, 14.1) and a positive attitude toward cervical cancer screening (AOR 3.57, 95%CI: 1.03, 12.30) were determinants of the utilization of cervical cancer screening. CONCLUSION: Being polygamous, having knowledge about cervical cancer, and having a positive attitude toward cervical cancer screening were determinants of the utilization of cervical cancer screening. Therefore, this study recommended that North Ari health services could increase health education for people with monogamous, poor knowledge about cervical cancer and a negative attitude toward cervical cancer screening through health campaigns in communities to enhance the utilization of cervical cancer screening.
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.
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
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.
DETERMINANTS OF PODOCONIOSIS IN NORTHERN ZONE OF SIDAMA REGION, ETHIOPIA: AN UNMATCHED CASE- CONTROL STUDY
(Hawassa University, 2024-08) MELKAMU UGAMO
Background: Podoconiosis is a type of elephantiasis caused by long-term barefoot exposure to red clay soil. It is a debilitating disease that leads to disability and stigma. Despite the widespread prevalence of podoconiosis, the determinants of it remain largely unexplored, especially within the context of the Sidama region. The findings will contribute to a comprehensive understanding of the determinants, facilitate the development of targeted prevention strategies in the specified region, and bridge the existing knowledge gap pertaining to determinants in southern Ethiopia. Objective: To identify the determinants of podoconiosis in the Northern Zone of Sidama Region, Southern Ethiopia, in 2024. Methods: An unmatched case-control study design was employed in selected districts within the northern zone of the Sidama Region. The cases comprised 191 randomly selected individuals with clinically confirmed podoconiosis and a negative filarial test. The controls consisted of 383 randomly selected individuals who exhibited no signs or symptoms of podoconiosis. Data were collected through structured interviews conducted using the KoBo mobile application. Both bivariable and multivariable logistic regression analyses were performed to evaluate the associations between potential determinants of podoconiosis. Statistical significance was declared at a p-value of less than 0.05. The magnitude of the association was presented using the adjusted odds ratio (AOR) with a 95% confidence interval. Results: A total of 574 (191 cases and 383 controls) participants were included in the study. Age ≥50 years (AOR=2.61; 95% CI: 1.22, 5.58), no formal education (AOR=3.04; 95% CI: 1.06, 7.73) , primary education (AOR=3.67; 95% CI: 1.32, 10.20), not wearing shoes (AOR=4.10; 95% CI: 1.72, 9.79), having unclean feet (AOR=4.80; 95% CI: 2.84, 8.11), purchasing no or a pair of shoes in a year (AOR=2.61, 95% CI: 1.48-4.61), poor knowledge (AOR = 3.52; 95% CI: 2.14, 5.78) and negative attitude (AOR = 1.80; 95% CI: 1.11-2.94) were significantly associated with podoconiosis. Conclusions: The study identified older age, lower educational attainment, not wearing shoes, poor foot hygiene, buying no shoes or a pair of shoes in a year, poor knowledge, and poor attitude as significant factors for podoconiosis. Multifaceted interventions on awareness- creation education, consistent shoe use and foot hygiene, and changing attitudes towards podoconiosis are crucial to mitigating this neglected tropical disease in endemic regions.
DETERMINANTS OF PODOCONIOSIS IN NORTHERN ZONE OF SIDAMA REGION, ETHIOPIA: AN UNMATCHED CASE- CONTROL STUDY
(Hawassa University, 2024-06) MELKAMU UGAMO (BSC)
Background: Podoconiosis is a type of elephantiasis caused by long-term barefoot exposure to red clay soil. It is a debilitating disease that leads to disability and stigma. Despite the widespread prevalence of podoconiosis, the determinants of it remain largely unexplored, especially within the context of the Sidama region. The findings will contribute to a comprehensive understanding of the determinants, facilitate the development of targeted prevention strategies in the specified region, and bridge the existing knowledge gap pertaining to determinants in southern Ethiopia. Objective: To identify the determinants of podoconiosis in the Northern Zone of Sidama Region, Southern Ethiopia, in 2024. Methods: An unmatched case-control study design was employed in selected districts within the northern zone of the Sidama Region. The cases comprised 191 randomly selected individuals with clinically confirmed podoconiosis and a negative filarial test. The controls consisted of 383 randomly selected individuals who exhibited no signs or symptoms of podoconiosis. Data were collected through structured interviews conducted using the KoBo mobile application. Both bivariable and multivariable logistic regression analyses were performed to evaluate the associations between potential determinants of podoconiosis. Statistical significance was declared at a p-value of less than 0.05. The magnitude of the association was presented using the adjusted odds ratio (AOR) with a 95% confidence interval. Results: A total of 574 (191 cases and 383 controls) participants were included in the study. Age ≥50 years (AOR=2.61; 95% CI: 1.22, 5.58), no formal education (AOR=3.04; 95% CI: 1.06, 7.73) , primary education (AOR=3.67; 95% CI: 1.32, 10.20), not wearing shoes (AOR=4.10; 95% CI: 1.72, 9.79), having unclean feet (AOR=4.80; 95% CI: 2.84, 8.11), purchasing no or a pair of shoes in a year (AOR=2.61, 95% CI: 1.48-4.61), poor knowledge (AOR = 3.52; 95% CI: 2.14, 5.78) and negative attitude (AOR = 1.80; 95% CI: 1.11-2.94) were significantly associated with podoconiosis. Conclusions: The study identified older age, lower educational attainment, not wearing shoes, poor foot hygiene, buying no shoes or a pair of shoes in a year, poor knowledge, and poor XIII attitude as significant factors for podoconiosis. Multifaceted interventions on awareness- creation education, consistent shoe use and foot hygiene, and changing attitudes towards podoconiosis are crucial to mitigating this neglected tropical disease in endemic regions.
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.