Browsing by Author "Bune, Girma Tenkolu (Phd)"

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    Metabolic Syndrome: Epidemiology and Sociocultural Contexts, among People Living with HIV, in Gedeo Zone, Southern Ethiopia.
    (Addis Abeba University, 2021-04) Bune, Girma Tenkolu (Phd); Prof. Worku, Alemayehu (MSc, PhD); Dr. Kumie, Abera (Ph.D.)
    Background: following an intensive global operation of antiretroviral therapy (ART), the worldwide morbidity and mortality from infectious diseases have occupied a backseat. Instead, a non-communicable diseases (NCDs) risk marker called metabolic syndrome (MS) has emerged. MS is risk factors for cardiovascular disease that has public health issue, which places social, economic, and disease conditions on the community within the geographical region of subSaharan Africa, including Ethiopia. Litreatures have shown that human immunodeficiency virus (HIV) infected patients on ART have a 2-fold risk of dying from MS. There are no such studies in Gedeo zone, southern Ethiopia; hence the need for this study to fill this gap. Objective: To assess the epidemiology and the socio-cultural contexts of metabolic syndrome among people living with HIV (PLHIVs), in the Gedeo Zone, Southern Ethiopia. Methods: This dissertation was conducted in the randomly selected two hospitals and health centers. A mixed approach was used to address the objectives of this dissertation. To estimate and compare the magnitude of overall MS among the two comparative groups, a comparative cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals and two health centers, exist in the Gedeo zone, southern-Ethiopia (Paper I). The data collection for this study was run beginning from December 29 th , 2017 up to January 22 nd − 2019, using the WHO steep tool. Ultimately, the completed data was entered into Epidata (V-3.1) and exported to SPSS (V− 22) for analysis. The revised Adult Treatment Panel three (ATP III) criterion was used to define the overall MS and its corresponding traits. The mean, standard deviations, and proportions were used as a descriptive summary. Categorical data and the proportion of overall MS in the two groups were compared using binary logistic regression, and results were reported statistically significant at a p-value is less than 5%. To identify predictors of metabolic syndrome among PLHIVs (Paper-II), a health institution-based unmatched case-control study was conducted. All HIV-infected adult persons who are receiving routine care in the randomly selected two hospitals and two health centers of the Gedeo zone were involved in the study, from December 29 th, 2017 to January 22nd, 2019. The PLHIVs diagnosed with overall MS using ATP III criteria were considered as a case, and those subjects free of it in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. In the crude analysis, all variables significant at (P<0.1) were included in a multivariable logistic regression model, using the enter method to arrive at the final model. In which, the adjusted odds ratio (AOR) with 95% CI, was estimated to assess the presence and strength of associations, and was determined statistical significance at a p-value < 0.05. To understand the role of sociocultural contexts in forming individual PLHIVs' behavior towards lifestyle-related MS risks, a deductive descriptive phenomenological approach, using the PEN-3 model as a theoretical basis and the knowledge, attitude, and practices (KAP) as a conceptual framework were used. Adult PLHIVs were chosen purposefully from Dilla University referral hospital and Wonago health center and were involved in the discussion. The data collection was enhanced with a focus group discussion (FGDs) and an in-depth interview method, starting from February 1 st to 30 th 2018. Finally, the primary data produced from the discussions were handled and analyzed iteratively, by using Atlas. ti (Version.7.5.7) and SPSS (Version.22) software. Result: a total of 633 (n=422, ART exposed and n=211, ART naïve) PLHIVs were involved in the first paper, with a response rate of 92.1%. MS was diagnosed in (22.0%, 95% CI: 19.0-25.4) of PLHIVs. It was slightly higher in the ART-exposed (22.5%, 95% CI: 18.7-26.8) than ART naïve (20.9%, 95% CI: 15.2-27.1) group. However, the observed differences were not statistically significant(P>0.05). In paper two, a total of 633 (139 cases and 494 controls) PLHIVs were included. The multivariable analysis result found that age (AOR=1.09, 95% CI (1.05-1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.020.42)); occupational status being of students (AOR=0.11,95% CI (0.24-0.51); wealth index being in the middle quintile (AOR=0.22, 95%CI (0.06-0.79)); ART status exposed to ART (AOR=3.07, 95%CI(1.37-6.89)); total physical activity state being physically active (AOR=0.36, 95%CI (0.16-0.79)), and engaged in low levels physical activity (AOR=3.83 , 95%CI(1.4610.05)) were the factors significantly associated with MS. Furthermore, the result from the third paper revealed that a total of 32 male and female respondents were involved in the discussion. More than half, 68.8 %(22) of the subjects were found within the age range of (35-44) years, with a mean age of 36.96 (+8.94) years-old. The getting hold of MS risk associated health knowledge of a person encompasses multiple sources. Family, the spouse's children, sisters, and brothers; the government structure, mainly the health care structures; the social systems, principally, the religious organization, the social calls 'Idir', were primary role player in educating the PLHIVs. Conclusions and recommendations: Paper one demonstrated that the magnitude of overall MS was higher among PLHIVs in the Gedeo zone; with a relatively higher magnitude seen in the ART-exposed than ART naïve groups. However, the observed differences were not statistically significant. Implicated that at the time of implementation of the entire test and treatment policy in those vulnerable target groups, a routine screening program of MS will be a vibrant action. While education, occupation, wealth index, antiretroviral therapy status, total physical activity, and lower physical activity levels were concluded by the second paper as modifiable predictors of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic syndrome. This suggested that there is a need for an ongoing effort to realize an integrated care plan that addresses the routine care, along with the regular screening and management programs of the risks associated with MS and its traits in these subjects. The sociocultural contexts dictate the PLHIVs' to have inadequate knowledge concerning risk factors and methods for preventing MS. And, this, in turn, contributed to form an unfavorable attitude and inadequate practices. The finding indicates the significance of the adoption of the healthy living practices associated awareness creation program, which targets the PLHIVs to bring behavior change that eventually enable them for the better prevention and control of MS and its long term consequences.