Browsing by Author "Negussie Deyessa"

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    Assessment of Quality of ANC Service and its Association with Intention to Deliver in Public Health Facilities in Bishoftu Town, Oromia, Ethiopia.
    (Addis Abeba Universty, 2017) Meseret Denu; Negussie Deyessa
    Background: ANC plays an important role in reducing maternal mortality and morbidity by detecting early risk factors in order to have an effective intervention in time and by linking the pregnant women to a planned delivery with a skilled birth attendant. Quality Antenatal care service can save the life of many pregnant mothers. Understanding quality of antenatal care in a health facility may be important for improvement of the service that could increase utilization of facility delivery. Objective of the study: To assess the quality of antenatal care and its association on intention to deliver in public health facility among ANC service utilizes in Bishoftu town. Method: Cross- sectional study supplemented by qualitative method was done at four public health facility found in Bishoftu town. Data was collected by using questionnaires at exit interview of clients, on provider competency and facility supply. Observational check list was used for provider performance. The study was conducted among 352 mothers who come for antenatal care service at the facility and health professional working at ANC clinic. The data was cleaned and analyzed by using statistical soft ware SPSS version 21. Result: This study showed that overall satisfaction of client was as high as 84.9%. The satisfaction of women with secondary educational level was lesser than illiterate pregnant women (AOR = 0.32; 95 % CI, 0.11, 0.93).Others those who were poorly satisfied were because of long weighting time to get the service. This study also showed that higher proportion of health care providers were provide proper advice and information related to complications can occur during pregnancy. Health facilities have basic structural and medical equipments which was important to give ANC service. This study showed that pregnant women getting satisfaction on ANC service have great willingness and intention to give birth at health facility. Conclusions: Overall satisfaction of antenatal care is high most of health care providers give Proper antenatal care service and health facilities were equipped with essential medical equipment and drugs for ANC service provision. Recommendation: To increase the ANC service satisfaction it is important to decrease waiting time at facility to get service. It is important to increase number of health care provider and extra room for ANC service provision and to improve service on recording and registration room.
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    Assessment of Sexual Coercion Among Addis Ababa University Female Students
    (Addis Abeba Universty, 2004-05) Seblework Tadesse; Negussie Deyessa
    Cross-sectional institution based survey using self-administered anonymous questionnaire and Focus group discussion, was conducted among female students of Addis Ababa University to determine the magnitude, immediate consequences and socio demographic correlates of sexual coercions. A total of 612 female students were involved in the study. The quantitative study revealed that the prevalence of lifetime completed and attempted rape was 12.7 %( 95%CI, 10.06, 15.33) and 27.5% (95%CI, 3.96, 31.3) respectively. Sexual harassment in lifetime and 12 month period was reported in 58% and 41.8% of students, respectively. Rape was significantly associated for those students, who have boyfriends, and from divorced family as a risk factor, and for those living with both parents before joining university and money sent as needed with near by living families as a protective factor. Promise by friends, physical force and alcohol use were also contributing to the offence. Unwanted pregnancy, abortion and psychological disturbances were the immediate reported consequences of rape victims, which signify the role of rape in these health problems. After their victimization 93.6% of the victims didn't share the event with anybody. Victims reported about the perpetuator that 93.6% was a person known by them. The findings of this study indicate that female adolescents even in higher educational level are at higher risk of sexual coercion and its consequences. It is recommended that sexual coercion needs attention and action from concerned bodies, education for students on how to challenge gender norms and to create new models of healthy relationship, for the victim preparation of rape crisis center in health institution with standardized treatments for STDs, raising the awareness of policy making bodies in order to implement the existing punishment on the abusers and encouraging victims to report for legal bodies.
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    Assessment of VCT Utilization for HIV/AIDS among Government and Non-government Employees in Butajira, SNNPR, Ethiopia
    (Addis Abeba University, 2007-06) Mulugeta Wondwossen; Negussie Deyessa
    Background: It is only recently that voluntary counseling and testing services have been considered important as an entry point for prevention and care interventions for HIV/AIDS. Access to voluntary counseling and testing services, however, remains limited and the demand for the service is often low. Objective: The aim of this study was to assess magnitude of utilization of voluntary counseling and testing for HIV/AIDS and to identify factors and barriers that affect VCT utilization among government and non-government employees in Butajira town, SNNPR. Methods: This was a cross-sectional study that was conducted among 347 government and 349 non-government employee in Butajira town, Gurage Zone, southern Ethiopia. This study used two stage sampling, the first stage was cluster sampling to select randomly seven sectors from government organizations, and another seven blocks from non-governmental organizations, taking sectors and blocks as a sampling unit for government and non-government organizations, respectively. The study used a standardized and pretested questionnaire for the quantitative study and four focus group discussions for the qualitative study. Data was analyzed by binary analysis using the logistic regression in SPSS. Results: A total of 736 study participants were eligible in this study, 696 were willing to participate in the study, among these 347 (49.9%) were government employees and 349 (50.1%) were non-government employees. The mean age of the respondents was 31.2 years. The magnitude of VCT utilization in the study participants was 37.9% with a 95% CI (34.3% and 41.5%). Voluntary counseling test utilization was higher to statistically significant level among female participants, higher educational status, married individuals and individuals having a monthly income of 1000 birr or more than their referents. Conclusion: The current study demonstrated that VCT utilization is low in Butajira town although it is higher than the reported prevalence for urban areas n the country. The result of this study indicates that VCT users are mainly government employees and females.
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    Association Between Job Dissatisfaction and Work- Related Stress among Health Professionals Working in Public Health Centers in Yeka Sub City of Addis Ababa.
    (Addis Abeba University, 2020-03) Dereje Abdisa; Negussie Deyessa; Gashaye Asrat
    Background: Work-related stress is one of the health problems modern societies have to deal with. Such stress is the second most reported work-related health problem next to musculoskeletal disorders. Job dissatisfaction could be one reason for work-related stress. However, there is no clear and sufficient evidence showing the relationship between job dissatisfaction and work-related stress in developing countries including Ethiopia. Therefore, the study is designed to assess the association between job dissatisfaction and work work-related stress among health professionals working in public health centers. Objectives: This study is mainly designed to assess the magnitude of work-related stress and to determine its association with job dissatisfaction among health professionals working in public health centers in Yeka Sub-city of Addis Ababa. Method: Health facility-based cross-sectional study was implemented among health professionals in Yeka Sub-city. Data was collected using self- administered structured questionnaires from a total of 519 samples of health professionals working in Yeka sub-city health centers. The level of job dissatisfaction was measured with multi-item scales derived from Satisfaction of Employees in Health Care (SEHC) while work-related stress was measured by Perceived Stress Scale (PSS-14). Data were entered into EpiData Manager 4.4.2.1 and analyzed using SPSS version 23. Both binary and multivariable logistic regression analyses were used to show an association between job dissatisfaction and work-related stress. The adjusted odds ratio was used to determine the strength of association. Result: A total of 499 health workers participated in the study and, among them 173 (34.70%) were males and 326 (65.30%) were females. The magnitude of work-related stress among health professionals was 53.3%, 95% CI (48.7, 57.90) and, 52.9%, 95% CI (48.7, 57.50) of study participants were dissatisfied with their job. After adjusting for potential confounder health workers who were dissatisfied with their job were more likely to have more work-related stress [AOR=2.47; 95%CI (1.67, 3.65)]. Additionally, sex of the health professions was independently associated with work-related stress. Male health professionals were less likely to report work related stress when compared to their female counter parts[AOR=0.61 ;95% CI(0.39,0.93)]. Conclusion: More than half of health professionals working public health centers are dissatisfied with their job and suffering from work-related stress. The study also found the presence of a strong association between work-related stress and job dissatisfaction among health professionals. Therefore, healthcare providers and policymakers should work to improve the human resource management system and maintain healthy working environment of the public health facilities so that workers job satisfaction is increased, health and safety of the workers is kept under control and hence work related stress is minimized.
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    The Association Between Medication Adherence and Cognitive Function Impairment among Hypertensive Patients a Case-Control Study in Mekelle, Northern Ethiopia
    (Addis Abeba University, 2020-10) Senait Alemayehu; Negussie Deyessa
    Background: Hypertension is a global public health problem. In developing countries, the high prevalence of hypertension followed by poor hypertension control remains a significant public health challenge. The brain is one of the main target organs affected by hypertension, excluding age hypertension is the most important risk factor for cerebrovascular pathology leading to cognitive function impairment. However, the level of antihypertensive medication adherence among hypertension patients and the difference in the development of cognitive function impairment is not well studied. Objective: This study aimed to assess the association between medication adherence and cognitive function impairment among hypertensive patients in Mekelle, northern Ethiopia from April to September 2020 G.C. Method: An unmatched case-control study design was conducted in the selected health facilities in Mekelle, Ethiopia from April to September 2020. The study population was hypertensive patients, aged 60 years and above and who have been on antihypertensive medications for at least 6 months. A sample size of 106 cases and 106 controls were included in the study, participants with cognitive function impairment were considered as cases, and participants without cognitive function impairment were controls. The data collection was done twice and the data were collected by reviewing the medical chart of patients and interviewer-administered questionnaire, by trained data collectors. Mini-Mental State Examination was used to assess the cognition status of the study participants and to assess the antihypertensive medication adherence, Morisky Medication Adherence Scale was used. The collected questionnaires were entered into Epi data version 3.1 and exported to SPSS version 23 for cleaning and further analysis. Bivariable and multivariable logistic regression was used for analysis. An adjusted odds ratio along with a 95% confidence interval and a p-value of < 0.05 was used for declaring statistical significance. Result: The prevalence of medication adherence was found to be 34(32.1%) among cases and 84(79.2%) among controls. Medication adherence was independently significantly associated to cognitive function impairment with [AOR =7.77, 95% CI: (3.44 -17.24)]. The odds of cognitive function impairment was 7.7 times more among antihypertensive medication non-adherent participants compared to those who were adherent. Marital status and educational status were also found to be significantly associated with cognitive function impairment. Conclusion and recommendation: There is an association between anti hypertensive medication adherence and cognitive function impairment after controlling for possible confounders. Further work needs to be done by the health professionals on informing patients about the consequences of elevated and/ or uncontrolled BP and on the benefits of medication adherence and the consequences of non-adherence.
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    Association of Antenatal Depression with Anemia and Adherence to Iron-Folic AcidSupplement among Pregnant Women Attending Antenatal Care Services at Health Centers in Yeka Sub-City, Addis Ababa, Ethiopia, 2019
    (Addis Ababa University, 2019-10) Miraf Mesfin; Negussie Deyessa; Gebretsadik Shibre
    Background: Depression affects a large proportion of the global population. It is reported to affect about a quarter of pregnant women in Ethiopia. Some studies indicate that anemia might be a risk factor for depression. This underscores the need for an iron-folic acid supplement (IFAS). IFAS adherence by pregnant women is however not satisfactory. Studies again implicate that depression might affect adherence to IFAS. Nevertheless, this potential vicious cycle is not a well-explored area of research. The objective of this study is therefore to assess the association of antenatal depression with anemia and adherence to IFAS among pregnant women attending antenatal care (ANC) at selected health centers. Methods: a facility-based cross-sectional study was conducted among pregnant women who attended ANC service in Yeka sub-city, Addis Ababa. A total of 406 pregnant women were recruited in the study. Patient health questionnaire (PHQ-9), a validated tool in Ethiopia, was used to assess antenatal depression. IFAS adherence was assessed using pill count method. Bivariable and subsequent multivariable logistic regression were employed for data analysis. Results: it was found that anemic pregnant mothers had an increased odds of having antenatal depression [AOR=2.63; 95% CI (1.13, 6.14)] compared to non-anemic mothers. Having financial hardship, whether current pregnancy is planned and emotional abuse from an intimate partner also significantly associated with antenatal depression. Antenatal depression at cut-off (PHQ 9≥5) failed to show statistically significant association with IFAS adherence. Major depression (PHQ-9≥10) was however found to be significantly associated with adherence to IFAS [AOR=1.97; 95% CI (1.09, 3.56)] in pregnant women. Besides, factors significantly associated with IFAS adherence were parity, knowledge of the use of IFAS and current pregnancy complication. Conclusion: the study revealed a significant association that exists between two important public health problems, anemia and antenatal depression; and the association between antenatal depression and IFAS adherence. Further investigation of these associations is a warranted area of future studies. In the meantime, putting these underlying determinants into consideration is beneficial as they might complicate diagnosis and have a negative impact on treatment outcomes.
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    The Association of Overweight and Obesity with Gestational Diabetes Mellitus in Pregnant Women Attending Ante Natal Care in Selected Hospital in Addis Ababa, Ethiopia, 2019/2020
    (Addis Abeba University, 2021-06) Mesfin Yeabsra ; Negussie Deyessa; Yimer Seid; Wondimu Ayele
    Background: Gestational Diabetes Mellitus (GDM) is associated with a higher incidence of maternal, perinatal, and neonatal morbidities. Publication around the world showed that overweight and /obesity is a potential risk factor for gestational diabetes mellitus. Because of late antenatal care booking in our country and self-report of pre-pregnancy body mass index is not reliable, it’s difficult to get pre-pregnancy or early pregnancy body mass index to measure overweight and obesity. Despite the increment in the incidence of overweight and obesity in our country, there is limited study showing the association of overweight and obesity with GDM in pregnant women and even the available studies lack consistency in findings. Objective: This study aims to assess the association of maternal overweight and obesity with gestational diabetes mellitus in pregnant women in selected hospitals of Addis Ababa from March 10 to July 30, 2020. Methods: An unmatched case-control study was conducted on 159 pregnant women with GDM (case) and 477 pregnant women without GDM (control) in selected hospitals in Addis Ababa. Each hospital had been conducted screening of GDM for high-risk pregnant women and diagnosis was made using the 2013 World Health Organization (WHO) criteria by a physician. Overweight and obesity were measured using Mid-Upper Arm Circumference (MUAC) and Calf Circumference (CC). Descriptive statistics used to present the sociodemographic profile of the study participants. Binary and multiple logistic regression analyses were done to measure the association of overweight and obesity with GDM. Finding was reported using adjusted odds ratios with 95% confidence interval and statistical difference was declared at P-value <0.05. Result: GDM was associated with obesity (MUAC ≥33 and CC ≥39 cm) (AOR = 2.80; 95% CI: 1.58–4.90) but not with overweight (MUAC ≥ 28 cm) (AOR = 1.51; 95% CI: 0.71–3.21). Previous history of caesarean section (AOR = 1.91; 95% CI: 1.14–3.21), having inadequate minimum dietary diversification score (<5) (AOR = 3.55; 95% CI: 2.15–5.86), engaging in low and moderate physical activity (AOR = 3.56; 95% CI: 1.49–8.48) and (AOR = 1.99; 95% CI 1.17–3.40) also associated with the development of GDM. Conclusion and Recommendation: Obesity but not overweight have found to be significantly associated with the development of GDM. Thus, screening for GDM is recommended for obese pregnant women (having MUAC ≥33 and CC ≥39 cm). Policy makers also should plan policies to decrease obesity among women of childbearing age before and in between conception. Antenatal care providers should provide information for women of childbearing age on maintaining a healthy body weight before and in between pregnancies, the need for healthy diversified food and physical activity.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-06) Zinabu Feyissa; Negussie Deyessa; Wondimu Ayele
    This document contains all the work expected from Field Epidemiology trainee in Addis Ababa University School of Public Health for fulfillment of Master of Science Degree in Field Epidemiology. Starting from October 2017 to end of April 2019, I have been in Ethiopia Field Epidemiology Training Program, School of Public Health Addis Ababa University and Oromia Regional Health Bureau Field Base. We have carried out two outbreak investigation, One surveillance data analysis, one surveillance system evaluation, one district health profile description, two scientific manuscript for peer reviewed journals, two abstracts for scientific conferences, one Disaster Narration, one epidemiological research proposal and additional outputs like training for health professionals and weekly bulletin preparations. Chapter I: we conducted two measles outbreak investigations. We identified 82 measles cases with no deaths in Dawe Serer district of Bale Zone with overall attack rate of 0.49%. Only 7(8.5%) was vaccinated. Travel history to measles affected area and contact with measles cases were identified risk factor by case control study. Increasing routine vaccination and mass vaccination of less than 15 years of age was recommended. We identified 280 measles cases and 5 deaths in Hawi Gudina district of West Harerge zone with overall attack rate of 3.8 per 1000 populations and Case fatality rate of 1.8%. Majority 149(53.2%) was not vaccinated and district measles vaccination coverage was 67% in 2018. Low vaccination coverage was cause of outbreak and we recommend increasing routine vaccination and supplemental immunization activities for under 15 years age groups. Chapter II: we analyzed surveillance data of meningococcal meningitis of Oromia Region from 2013-2017. We identified 2665 cases and 74 deaths and incidence rate was 1.57 per 1000 population with case fatality rate of 2.78%. We recommend strengthening routine surveillance system and aligning the PHEM and monthly HMIS reports. Chapter III: we conducted malaria, measles and MDSR surveillance system evaluation in Oromia Special zone Surrounding Finfinne at 13 sites from December 06-21, 2018. The system was found to be useful, representative and flexible. Preparing Emergency Preparedness and Response Plan, conducting supportive supervision and Restoring function of committees are important to sustain the system on track.AAU, SPH, Compiled Body of Work, EFETP, Zinabu F, 2019 zinabu99@gmail.com XIII Chapter IV: we prepared health profile description of Berek district of Oromia Region from February 12-24, 2018. Leading cause of morbidity in all ages was Acute upper respiratory infection 2833 (26.12%) and in < 5 years children was Diarrhea (non bloody) 1383 (39.82%). Chapter V: we prepared scientific manuscripts for peer reviewed journals on meningococcal meningitis surveillance data analysis of Oromia Region, Ethiopia 2013-2017 Chapter VI: we prepared two abstracts for scientific conferences on measles outbreak investigation and response in Dawe Serer District of Bale Zone Oromia Region Ethiopia 2019 and meningococcal meningitis surveillance data analysis of Oromia Region, Ethiopia 2013-2017. Chapter VII: we conducted Internally Displaced Population health need assessment in Meda Welabu District of Bale zone Oromia Region Ethiopia from April 12 to 25, 2019. Chapter VIII: One epidemiologic research project proposal was prepared on LLIN utilization status and Malaria surveillance system evaluation in Sebeta Haws District, Oromia Region,Ethiopia 2019. We will conduct a community based cross sectional study on 616 households for LLIN utilization and institution based on system evaluation at 12 sites. It was estimated to cost 2978 USD. We have got award from Presidents Malaria Initiative to conduct study so we will start study as soon as fund was released by organization in the near future. Chapter IX: we gave training on basic PHEM for zonal, district and health facility level PHEM focal persons who came from two zones and two town health offices. We had prepared 5 Weekly epidemiologic bulletin of Oromia regional Health Bureau. The bulletin serves to summarize weekly surveillance data and performance of the region on epidemic prone diseases and other public health emergencies and to give feedback to the reporting agencies. We have attached weekly bulletin prepared on week 01, 2019 as a sample among others.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-06) Natnael Teferi ; Negussie Deyessa; Girma Taye
    Field Epidemiology Training Program (FETP) program in field epidemiology adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) program and designed to assist the Ministry of Health in building or strengthening health systems and improve leadership within Public Health Emergency Management. The EFELTP provides residents a Master of Public Health in Field Epidemiology after complete two years of supervised work in applied or field epidemiology. The program has two main components: Classroom-teaching component (25%) and practical attachment or field placement component(75%). The role of public health practitioners includes ensuring effective health promotion, disease prevention and control activities by conducting surveillance on emerging public health threats and providing continues information to policy makers and public health officials.From October, 2017 to up today, I have stayed in Field Epidemiology Training Program, School of Public Health-AAU and at both EPHI and Oromia Regional Health Bureau field base. I learned a lot of public health activities during my stay. This document is compiled body of works accomplished during the two years stay at field base of the field epidemiology training program in Addis Ababa University- School of Public Health. Chapter I: We conducted two epidemiological investigation of outbreak (Malaria and Measles). We used both descriptive and Analytical epidemiology for both outbreaks to describe the pattern and magnitude of the diseases and identify associated risk factors with the outbreak. A total of 348 confirmed malaria cases with no death was identified during February to March 2018 in Darimu Woreda of Iluababora zone, Oromia region. We identify Presence of mosquito’s vector/breeding sites, unprotected dam for irrigation, and similar sick patient in the house hold as independent risk factors for malaria outbreak in the woreda. Poor in detection, notification of the outbreak and implementation of larva control measures are a toll for this outbreak. we recommend strengthen malaria surveillance system, identifying potential vector breeding site, Proactive vector control, redistribution of the ITN prior to malaria season and address utilization gaps on bed net through health education. Measles outbreak in Liben woreda of Guji zone, Oromia region. we investigate from December 12 to 20, 2018. A total of 15 measles cases were identified and 3/5 tested were confirmed by measles specific IgM antibody test. Traveling history to adjacent Woreda, presence of measles cases in the house and being unvaccinated are found to be independent risk factor for this outbreak. Religious exemption is identified as major factor for being not vaccinated, which is opposed the>100% vaccine coverage report of the woreda. Target measles vaccination with vitamin A supplementation amongst under five, Suspension of public collection from suspected measles cases rumour reported, health education on religious area, strengthen cold chain management and furthers study on vaccine acceptance and associated factor with sufficient sample size were recomended. Chapter II: We conduct Five-year (2013-2017) malaria data analysis at south west shoa zone and describe by person, place and time. Malaria cases in the zone were decreased by 80.5 percent by 2017 compared to the baseline year of 2013. The zone was in line with achieve high level National malaria strategy plan. Burden of malaria cases was still high among three Woredas. Peak malaria case between September and December. We recommend ITN’s distribution and IRS for respective high malaria endemic woreda and scale up of malaria prevention and control intervention prior to the respective period and harmonizing HMIS and PHEM system at all reporting level in order to generating reliable and quality data. Chapter III: We conducted Evaluation of surveillance system from February 01-18, 2019, in Bale zone. (N=43): Measles surveillance was selected and assessed. The system in place found to be simple, flexible and stable in operating well without interruption and helpful in case detection but not useful (fail) to meet objectives of surveillance for action and low in representativeness andacceptable. We recommend widen the surveillance chain among private health facilities, upgrading data management to electronic at all level. Chapter IV: We conducted description of Health profile in Gindeberet Woreda, West Shoa Zone, Oromia region February 10 to 30, 2018. we found Acute febrile illness, pneumonia and acute upper respiratory tract infection were leading causes of adult morbidity and very low TB and HIV case detection. We recommend, targeted HIV counseling and testing. Chapter V: We prepared scientific manuscript for peer reviewed journals on Malaria outbreak investigation in Darimu woreda, Iluababora Zone 2018. The manuscript was prepared according to Ethiopian journal of health development authors guideline. Chapter VI: We prepared two abstracts for submission to scientific conference: - 1. Measles Outbreak Investigation in pocket area of Liben Woreda, Guji Zone, Oromia Region, Ethiopia- December, 2018. 2. Malaria Outbreak Investigation Darimu Woreda of Iluababora Zone, Oromia Region, Ethiopia, March 2018. Chapter VII: We conduct Narrative Summary of Disaster situation report (Meher Assessment) at three Zone of Agro pastoral zone of Oromia Region (Guji, West Guji and Borana) from November 22 to December 12, 2019. There were increased malnutrition case, because of double burden effect of high influx of IDPs and drought in all accessed zones. With this junction, there is emergency nutrition intervention/supply stock out in West Guji and Borana Zone. We recommended the RHB and FMOH should fill the gaps/shortage of nutrition supplies, emergency drug and ensure capacity for timely response. Chapter VIII: Epidemiological research project was prepared on ITNS Utilization and associated factors among settler’s population in Darimu woreda of Iluababora Zone, Oromia Region 2019. Community based cross sectional study will be conducted from April to May/2019. Multi-stage sampling technique will be used to get study subjects. Sample size will be determined by using Epi info by using 80% ITNs utilization from pervious study. Total 541 household will be assessed in this study and 37,966.96 ETB estimated budget requiring. Chapter IX: Training was given for 59 Health professionals working at Woreda and Health facilities of two zones from December 22-25, 2018. The training was organized by Oromia regional health bureau with collaboration of WHO at Ambo Town. The training was addressed overview of PHEM System, Public Health Emergency Preparedness, Epidemiology of 20 Notifiable Diseases, Early Warning Prevention, Health Emergency Response and Recovery. The training was supported by practical demonstration and group work presentation. Lack of printed training manual is a challenge, so we recommend training preparation should de include all necessary format and manual for trainers. Also I participate in different trainings and conferences in different places, namely: - I have attended AFENET Scientific conference at Addis Ababa June 2018. I have attended the training of Disaster Medical Assistance Team as central DMAT member at Bishoftu town from January 21-27,2019. I participate on Regional semi-annual PHEM review at Adama from February 1114/2019 and Public Health emergency preparedness and response on public mass-gathering at Kulib-Gebril Celebration December 2018.Other additional output: I conduct Six Regional public health emergency Weekly bulletin. I am including only one of weekly bulletin in this document. Weekly bulletin results were disseminated for all Zones, Administrative Towns, Regional PHEM staff and different stakeholders including governmental and non-governmental organization on weekly bases.
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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa Universty, 2018-06) Dereje Dechasa; Negussie Deyessa
    This document contains two years Field Epidemiology Training Program outputs, to be submitted to school of public health for fulfillment of Master Degree in Field Epidemiology. This Compiled Body of Work has seven chapters. Two Reports of diseases outbreak investigations, public health surveillance data analysis, surveillance system evaluation, Health profile assessment, scientific manuscript, and scientific abstract and Epidemiological research project proposal. Chapter one: This chapter describes about two outbreak investigation reports. The first outbreak is measles outbreak investigation conducted in Kibebe-tsehay orphanage, Gulele sub city, Addis Ababa in 2017. The objective was to describe the magnitude of the outbreak and to identify risk factors associated with the outbreak. We used unmatched case control study design with the case to control ratio of 1:2.The outbreak affected 45 persons with the attack rate and case fatality rate of 20.6% and 8.9%, respectively. Contact history with measles cases was significantly associated with measles infection after adjusting all other factors. Addis Ababa health bureau, Gulele sub city and the affected woreda health offices need to achieve and maintain high measles vaccination coverage to increase population immunity and improve measles case management based on WHO recommendation. The second outbreak is rubella outbreak investigation conducted in woreda 03, Nifas Silk Lafto sub city, Addis Ababa in 2018. The objective was to describe the magnitude of the outbreak and take control and prevention measures. In this outbreak a total of 45 Rubella cases with crude attack rate of 0.1 and no deaths were reported. The age-specific attack rate was high (0.9) for age group 1-4 years. Sex specific attack rate was 0.2% for males and 0.1% for females. We recommended further study to describe the extent of the that Addis Ababa health bureau in collaboration with Federal ministry of health and partners need to consider the introduction of rubella vaccine. Chapter two: This chapter covers the malaria surveillance data analysis done in Addis Ababa from 2012-2016. The objective of the analysis was to describe the malaria cases in Addis Ababa. The incidence was ranged between 0.9/1000 in 2014 and 1.7/1000 in 2016. The five years average incidence was highest (4.2/1000) in Akaki. We recommended that Addis Ababa health bureau and respective sub city health offices need to encourage the travelers to malaria endemic area to sleep under insecticide-treated mosquito net and apply mosquito replant lotions. Chapter three: This chapter contains the malaria surveillance system evaluation report conducted in Nifas Silk Lafto sub city of Addis Ababa. The objective of this chapter is to address the systematic aspect of the gap identified during the analysis of five years malaria surveillance data done in Addis Ababa which is presented in chapter three of this document. The analysis report indicated that many of the studied woredas and health centers had no multi-sectoral task force and malaria epidemic preparedness and response plan. The Flexibility, predictive value positive and acceptability of malaria surveillance system were 54.2%, 65.2% and 78.1%, in their respective order. The woreda health offices and health center need to establish emergency task force and prepare malaria epidemic preparedness and response plan. They also need to aware the community and all stakeholders to improve the acceptability of the surveillance system. Chapter four: This chapter describes the health profile of Yeka Sub city. The objective of the assessment was to describe health and health related information and identify the priority health problem of the sub city. The assessment identified low contraceptive acceptance rate, low delivery service attended by skilled person and low outpatient department attendance per capita. The sub city reported low (37%) contraceptive acceptance rate, low (64%) delivery service attended by skilled person and low (0.99) outpatient department attendance per capita. Therefore, the health facilities, woreda and sub city health offices need to identify and intervene on factors contributed for these low performances. Chapter five: This chapter presents a scientific manuscript on malaria surveillance data analysis done in Addis Ababa city administration. The contents of this manuscript were described in chapter two of this summary. Chapter six: This chapter contains the scientific abstract prepared on malaria surveillance data analysis done in Addis Ababa city administration. Chapter seven: This chapter describes the Epidemiological project proposal prepared on Prevalence of malaria and associated risk factors among residents of Akaki kality sub city, Addis Ababa in 2018. The objective of the proposal is to determine the prevalence of malaria and identify the risk factors associated with malaria in Akaki kaliti sub city in 2018.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2021-03) Belay Regassa; Abdulnasir Abagero; Negussie Deyessa
    Background: Visceral Leishmaniasis (VL) is caused by Leishmania parasites that infect mammals transmitted by Phlebotomine and mostly affects the poorest. VL distributed worldwide and prevalent in Ethiopia. Knowing the occurrence and risk factor is a remedy for prevention and control. The aim of the study was to identify factors associated with VL. Methodology: Case control study was used during October-November 2019 in Borena. A 1:2 Cases to controls were identified by case definition and 33 cases were included in the study. Participants >18years interviewed and caregivers of <18 were questioned for legitimacy. Epiinfo and SPSS were used for data entry and analysis. Primarily predictors were identified using chi-square at significant level P<0.05 with 95%CI, then candidate predictors were analyzed using bivariate and multivariate analysis to identify associated factors. Result: Among 153 suspected cases, 9 suspected deaths reported; 33 (22%) cases and 3 deaths were verified for VL. Among 33 verified cases 15(45.5%) were in July 2019, in comparison of 4years data, there is surge cases in July-August 2019, 26(79%) of cases were from Dire, Attack Rate (AR) = 15/100,000, CFR=9.1%. Among all, 15-64year were highly affected with AR=19.3%. A case control engaged 99(100%) respondents and among all 93(93.9%) were male, 68(68.8%) were 15-64years. Adult education AOR = 30.438(2.378, 389.602), bed-net AOR=9.024 (1.763, 46.205) and walling AOR=0.052(0.004, 0.739) were associated factors with VL at 95%CI with p-value<0.05. Male 15-64years were highly susceptible. Level of education, ITNs and walling were associated factors with VL. Conclusion: Formulating policies and guidelines for male 15-64 years related vector control and awareness creation regarding feeding habit of sand fly, prevention and control were recommended. Awareness of community on prevention method; using repellents, ITNs utilization, and safe sleeping mechanisms are mandatory. Further investigation on the issue is best remedy to overcome future VL outbreak occurrence.
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    Compiled Body of Works in Field Epidemiology In Bale Zone, the Oromia Region of Ethiopia
    (Addis Ababa University, 2024-10) Eshetu Zeben; Negussie Deyessa ; Yimer Seid; Yonas Abebe
    Despite numerous interventions aimed at combating infectious diseases, they continue to pose a significant global health challenge. Prevention is a fundamental component of the Ethiopian government's policy agenda, which includes initiatives to bolster immune system strength. The Ethiopia Field Epidemiology Training Program, overseen by the U.S. Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS), endeavors to enhance the diagnostic and preventive capacities of public health professionals in relation to critical diseases. During my tenure at Addis Ababa University School of Public Health and the Oromia Regional Health Field Base (Bale Zone Health Office) from January 2023 to September 12, 2024, several notable activities were undertaken. These encompassed the analysis of severe acute malnutrition (SAM) survey data from January 3 to January 25, 2023, scrutiny of Woreda health profile data from February 13 to February 30, 2023, investigation of a cholera outbreak from January 19 to February 2023, monitoring of a measles outbreak from June 19 to September 17, 2023, and the production of a research paper on type 2 diabetes self-care practices and associated factors among patients attending public hospitals in the Bale Zone from February 5 to March 22, 2024. Additionally, we conducted various training sessions and composed essays and articles that were published in reputable journals. However, this document only includes detailed information from one weekly report, with access to others provided through hyperlinks. The measles investigation, conducted between June 27 and September 17, 2023, identified 48 cases and 2 deaths in Agarfa Woreda, Bale zone, Oromia Region. To address these issues, we suggest intensifying the utilization of the second measles vaccine and raising public awareness about its significance. Between January 2023 and February 2023, there were cholera outbreak 25 cases of Vibrio cholera, with no fatalities. The causes of cholera include security concerns, inadequate infrastructure, insufficient healthcare services, and lack of clean water. To combat this, we propose providing clean and adequate water, avoiding contact with infected individuals, actively identifying affected individuals, delivering emergency treatment, and developing cholera vaccines. Surveillance data analysis of severe acute malnutrition (SAM) in the Bale one health office demonstrated a gradual increase in cases over the years, particularly in 2020 G.C.; However, deaths resulting from SAM decreased during this period. The Surveillance Evaluation System on weekly disease and surveillance (WDSS) and Maternal and perinatal death (MPDSR) also assessed the comprehensiveness, reason-ability, flexibility, and effectiveness of the analysis and data management processes, although timeliness, consistency, and Representativeness were not always ensured. Maternal health services were generally commendable, but respiratory issues, diarrhea, and inadequate healthcare services were prevalent. The findings of all these studies are incorporated in academic reports prepared for submission to peer-reviewed journals. A research discussion was also developed, focusing on malnutrition (SAM) data analysis in the Bale zone , Oromia Region. In July 2023, a disaster assessment was undertaken to address the cholera outbreak affecting five villages in the Bale Zone district's of Oromia Region, aiming to identify people's needs and implement public health measures. The primary health concerns identified were diarrhea, malaria, and other infectious diseases. Our research study concentrates on type 2 diabetic patients admitted to public hospitals in the Bale Districts, Oromia Region, and their personal experiences with diabetes. We conduct our final thesis research on self-care practices and associated factors among type 2 diabetes mellitus patients attending public hospitals in Bale zone, Oromia region, Ethiopia. We selected 411 patients for a cross-sectional study using systematic random sampling and collected information regarding social factors, medical records, diabetes self management, medication adherence, and self-care via the Kobo tool database. The findings indicated that 59.4% of Type 2 Diabetes Mellitus patients demonstrated good self-care level, while 40.6% exhibited poor self-care behavior. Enhanced self-care was positively associated with higher income, self-employment, diabetes education, membership in a diabetes organization, knowledge about care, positive self-esteem, and absence of diabetes complications. Furthermore, We present the weekly epidemiological bulletin from the Public health emergency management (PHEM) reports of the Bale zone health office and Oromia Regional Health Directorates for weeks 1-4, 28- 41, and 42-49 of 2023.
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    Diabetic Health Literacy And Blood Glucose Control among Patients with Diabetes at Public Health Facilities in Bishoftu Town, Oromia, Ethiopia 2023/2024: Case-Control Study
    (Addis Ababa University, 2024-06-13) Lidya Asmelash; Negussie Deyessa
    Background: Uncontrolled blood glucose levels in most diabetes patients result from poor diabetes health literacy and are linked with significant mortality and morbidity. Diabetes patients with poor diabetic health literacy may have inadequate glycemic control likely to experience complications from the disease. However, insufficient studies support such a hypothesis in most low-income countries. Therefore, the main goal of this study is to investigate the link between diabetic health literacy and blood glucose levels in diabetic patients. Methods: A health facility-based case-control study was carried out in Bishoftu town, involving all individuals diagnosed with DM who began follow-up. Cases included diabetic patients with uncontrolled blood glucose, while controls consisted of diabetic patients with controlled blood glucose. The sample size was determined using Epi-Info, comprising 94 cases and 276 controls. A structured, interview-administered questionnaire was utilized to gather data. The data analysis was conducted using STATA version 17. Descriptive analysis was conducted using simple frequencies and cross-tabulations to examine sociodemographic characteristics and other independent variables. Bivariate data analysis checked the correlation between diabetic health literacy and other independent variables against blood glucose level. Moreover, a multivariable analysis using binary logistic regression was conducted to identify independent predictors of blood glucose levels. Results: In this study, average age (SD) to the cases and the controls were 48 (17.2) and 47 (17.3), respectively. Diabetic patients with uncontrolled blood glucose levels were 4.7 times more likely to have an impact on low health literacy than patients with controlled blood glucose levels (AOR = 4.7, 95%CI: 2.16, 10.24) and 2.9 times more likely to have an impact on moderate health literacy than patients with controlled blood glucose levels (AOR = 2.9, 95%CI: 1.37, 6.02), Patients who exercised physically (AOR= 0.41, 95%CI: 0.21, 0.78), good treatment adherence (AOR= 0.44, 95%CI: 0.22, 0.87) were statistically significant factor with uncontrolled blood glucose level. Conclusion: The study conducted on the link among health literacy of diabetes and blood glucose control levels among diabetic patients was identified several factors such as low and moderate diabetic health literacy older age, engagement in physical activities and good adherence to treatment were associated with achieving the target of blood glucose level control.
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    Examining the Association between diabetic health literacy and blood glucose control among Patients with Diabetes at Public Health Facilities in Bishoftu Town, Oromia, Ethiopia 2023/2024: Unmatched Case-Control Study.
    (Addis Ababa University, 2024-06) Lidya Asmelash; Negussie Deyessa ; Yimer Seid
    Background: Uncontrolled blood glucose levels in most diabetes patients result from poor diabetes health literacy and are linked with significant mortality and morbidity. Diabetes patients with poor diabetic health literacy may have inadequate glycemic control likely to experience complications from the disease. However, insufficient studies support such a hypothesis in most low-income countries. Therefore, the main goal of this study is to investigate the link between diabetic health literacy and blood glucose levels in diabetic patients. Methods: A health facility-based case-control study was carried out in Bishoftu town, involving all individuals diagnosed with DM who began follow-up. Cases included diabetic patients with uncontrolled blood glucose, while controls consisted of diabetic patients with controlled blood glucose. The sample size was determined using Epi-Info, comprising 94 cases and 276 controls. A structured, interview-administered questionnaire was utilized to gather data. The data analysis was conducted using STATA version 17. Descriptive analysis was conducted using simple frequencies and cross-tabulations to examine sociodemographic characteristics and other independent variables. Bivariate data analysis checked the correlation between diabetic health literacy and other independent variables against blood glucose level. Moreover, a multivariable analysis using binary logistic regression was conducted to identify independent predictors of blood glucose levels. Results: In this study, average age (SD) to the cases and the controls were 48 (17.2) and 47 (17.3),respectively. Diabetic patients with uncontrolled blood glucose levels were 4.7 times more likely to have an impact on low health literacy than patients with controlled blood glucose levels (AOR= 4.7, 95%CI: 2.16, 10.24) and 2.9 times more likely to have an impact on moderate health literacy than patients with controlled blood glucose levels (AOR = 2.9, 95%CI: 1.37, 6.02), Patients who exercised physically (AOR= 0.41, 95%CI: 0.21, 0.78), good treatment adherence (AOR= 0.44,95%CI: 0.22, 0.87) were statistically significant factor with uncontrolled blood glucose level. Conclusion: The study conducted on the link among health literacy of diabetes and blood glucose control levels among diabetic patients was identified several factors such as low and moderate diabetic health literacy older age, engagement in physical activities and good adherence to treatment were associated with achieving the target of blood glucose level control.
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    Intimate Partner Violence During Pregnancy and Other Determinant Factors of Preterm Birth in Amhara Region, Ethiopia
    (Addis Ababa Universty, 2018-06) Abay Woday; Negussie Deyessa
    Background: Preterm birth (PTB) is a public health problem worldwide. However, the problem is under reported and underestimated in developing nations including Ethiopia. Moreover, limited research to date has been done to address the relationship between intimate partner violence during pregnancy and preterm births in developing nations including Ethiopia. This study aimed to assess the association between intimate partner violence during pregnancy and preterm births. Methods: Hospital based unmatched case control study design was employed on a sample of 138 cases and 276 controls from 1st February 2018 to 1st April 2018 in Amhara region, Ethiopia. The cases and controls were proportionally allocated in each hospitals based on the last one-year case flows. The outcome variable was measured by using confirmed Physician Diagnosis of prematurity. Standardized, structured and pretested questionnaire was used to collect data. The collected Data was entered using Epi-data 3.1 and was exported into SPSS version 20.0 statistical software for analysis. Independent variables with p-value less than 0.25 in the bivariate analysis were entered into multivariable logistic regression model with backward LR method. Statistical significance level was declared at p-value less than 0.05. Results: the overall proportion of any Intimate Partner Violence (IPV) exposure during pregnancy was found higher among case groups than control groups (44.8% and 25% respectively). After adjustment: women experienced any IPV during pregnancy had 2.5 times higher odds of Preterm birth compared to those never experienced any IPV [ AOR=2.85: 95%CI 1.42-6.22]. Moreover, the likelihood ratio of PTB among women experienced emotional IPV was 6 times higher compared to those didn’t experienced [AOR=3.05: 95%CI 1.35-6.91]. Other determinant factors such as; residence, maternal age, education level, ante natal care, previous adverse birth outcomes and medical problems during pregnancy were significantly associated with PTB. Conclusion: The study revealed significant association between Intimate Partner Violence during pregnancy and preterm birth. Therefore, programs and strategies should be developed to prevent women violence during pregnancy at regional, zonal and district levels. Health care providers should have integrated IPV screening at routine ante natal care delivery settings. Moreover, longitudinal and qualitative studies are recommended to explore more evidence.
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    Magnitude and Type of Physical Violence Against Married Women in Meskan and Mareko District Southern Ethiopia.
    (Addis Abeba Universty, 1996-05) Negussie Deyessa; Mesfin Kassaye
    The seriousness in magnitude of physical violence, and lack of information on the dimensions and context of the problem here in Ethiopia, have made this paper to be important. A cross-sectional survey and a focus group discussion were conducted in Meskanena Mareko woreda, South western Ethiopia, for a period of one month with an objective to assess the magnitude and types of physical violence against married women and its associated factors. A total of 673 married women were included in the study. The study found out the overall prevalence of physical violence on married women to be 45.0 % and 9.7 % in their lifetime and last three months, respectively. The type of physical violence most frequently observed was slapping or hitting a woman with a fist, kicking with leg, and hitting with stick or iron bar. The out comes of the physical violence ranged from small laceration to permanent damages. The study has also shown that khat chewing than not chewing (OR= 1.59, 95 % CI: 1.13, 2.23), marriage initiated by family than by self (OR= 1.94, 95 % CI: 1.14, 3.37), having history of parental spousal abuse than don't have (OR= 1.89 95 % CI: 1.37, 2.39), having social confidant than don't have (OR= 1.95, 95 % CI: 1.30, 2.97) and alcoholic than non alcoholic spouses were the most contributing factors to the increase in magnitude of physical violence against married women. We recommend policy makers to be involved to entail the problem and increase public awareness of physical violence and introduce enforcing law and other researchers to carry out an in depth study to identify circumstances of physical violence, what the community regards physical violence and to come up with further analysis in terms of spouses point of view.
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    Magnitude of Antibiotic Resistant escherichia coli and factors Associated with Antibiotic Resistance among Community Acquired Urinary Tract Infected Patients Attending Public Health Centers in Addis Ababa. Ethiopia
    (Addis Ababa Universty, 2018-01) Simegne Terefe; Negussie Deyessa
    Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans both in the community and hospital settings. It has estimated 150 million cases of UTI worldwide. E. coli is the most common Uro-pathogenic organism. Increasing resistance in E. coli has been reported globally and now considered as one of the major public health problem. Studies in Ethiopia frequently retrieve highest rate of antibiotic resistant in Uro-pathogenic E. coli isolates from hospitals. Community acquired urinary tract infection or uncomplicated (UTI) is mostly treated at primary health care empirically. There is scares data on this issue from health center where uncomplicated UTI is usually treated empirically. Therefore, Knowledge of the magnitude of antibiotic resistant in this organism and assessment of some patient’s activities related OR risk factors which contribute to antibiotic resistant at the community level is important for empirical treatment and future monitoring of antibiotics resistance at community level. Therefore, this study addresses this gap. Objective: To assess magnitude and factors associated with antibiotic resistant in E. coli among community acquired urinary tract infected patients at health center in A.A in the 2017. Methodology: institution based Cross-sectional study was conducted using quantitative methods. Multistage sampling procedure and simple random sampling technique were used to select Sub-cities and health centers. 266 study participants were selected based on their microscopic laboratory Result (urine pus cell count> 10/HPF). Data were collected using interview based questionnaire adopted from different literatures and standardized culture and susceptibility test results record form. Urine sample were collected and analyzed using standard methods. Finally, the collected data were cleaned, entered in to epi-data software and sent to SPSS. Then followed by Analysis of descriptive statistics, bivariate and multivariate respectively Result: About half of participant develops resistance to at least one of the seven antibiotics tested. Ampicillin was found to be the major resisted antibiotic for about three fourth of the seven antibiotics tested for drug sensitivity. Patients who had reported health service facilities were most accessible compared to pharmacies/drug shops; and patients who had taken antibiotics for less than seven days were found to be significantly associated with antibiotics resistance. Conclusion and Recommendation: In the study area resistance rates to Ampicillin were high. And Ciprofloxacin was the list resistant and recommended to empirical treatment in the area of study.
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    Magnitude of Sexual Abuse among Male High School Students in Addis Ababa.
    (Addis Abeba Universty, 2009-07) Rahel Tesfaye; Negussie Deyessa
    Background: sexual abuse as including any of the following acts committed by an adult or under: attempted or completed sexual intercourse (i.e., oral, anal, vaginal); touching, kissing, or rubbing up ; exhibiting their body parts ; or having the view any type of sex act. Objective: To determine the magnitude, contributing factors and the health consequence of sexual abuse among male high school students Addis Ababa city administration . Methodology: A cross-sectional descriptive study involving 884 randomly selected students among 9 Addis Ababa high schools was conducted in March 2009. Pre-tested questionnaire was used to collect data, which was entered and cleaned using EPI version 6 statistical packages and analysis of data was done using SPSS for windows, odds ratio with 95% confidence interval was made, and for independent variables that have borderline association with the dependent variable entered to a model to look for confounding effect. Results: As this study indicates, sexual abuse of boy students in Addis Ababa is common with a life time prevalence of rape and sexual harassment of 4.3%, and 68.2%, respectively. The chance of experiencing sexual coercion was higher among students who live alone (AOR = 2.87; 95% CI; 1.07, 7.66) and among students who live with others (AOR =1.80; 95% CI = 1.04, 3.11) than students living with both. Similarly, the odds of experiencing rape in their life time was higher among students who live with others (Adj OR=2.20; 95% CI; 1.04, 4.68) than those who live with their biological parents. Conclusion and Recommendation: Sexual abuse of boys is associated with those living alone or living out side their parents. Considering these findings, providing information, education and counseling service of students living outside their real biological parents is important.
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    Risk factors and Disabilities of Hypertension in Mettukarl Hospital, South-West Ethiopia: a Case Control Study.
    (Addis Ababa University, 2013-08) Muluneh Shuremu; Negussie Deyessa
    Background: Hypertension has been one of the greatest public health problems in all parts of the world, particularly, being double burden among developing nations with predominantly alarming trends. It is one of the top leading causes of morbidity and mortality among adults in Ethiopia, exactly as it is in the whole world. However, there is no adequate study pertaining to hypertension in general or factors associated with it particularly in a rural community setting. Objectives: The main purpose of this study was to assess the risk factors and levels of disabilities related to hypertension. Methods: A case - control study was conducted in Mettu Karl hospital. The study populations were patients who visited the hospital for medical care. Data were collected on a face to face using structured questionnaire by interviewer administrated questions. Anthropometric and blood pressure measurements were taken through standardized procedures. Data were entered, cleaned, analyzed, in EPi Info version 3.5.3.and exported to SPSS version 16.0 statistical software packages. Results: Participants involved in this study were (n = 114) cases and (n = 228) controls. This study revealed that there is statistically significant association between various risk factors and HTN. According to the finding; Residence, Income, cigarette smoking, alcohol consuming, khat chewing, family history of HTN, family history of central obesity, less physical activity, regular animal fat intake, sleep duration, nature of sleep, nature of routine work and BMI were significantly associated with the occurrence of HTN. Disabilities observed among hypertensive patients ranged from severe to extreme in performing a given activity. Conclusion: The study found out statistical significant level association between different risk factors and hypertension occurrence. Hypertensive patients have suffered from a range of disabilities to the level of extreme and severed situation. To prevent and control HTN as well as its complications lifestyle modification of the community, particularly the urban population is the big issue. Community at large, stake holders, mass media should pay attention against HTN. Since hypertension is a disabling disease infrastructures for disabled patients should be provided adequately. The government body and policy makers expected to work against hypertension occurrence. Further study is encouraged.
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    Survival to Recovery in Children With Severe Acute Malnutrition Treated at Outpatient Therapeutic Care Program in Southern Ethiopia.
    (Addis Abeba University, 2013-06) Melkamu Merid; Negussie Deyessa
    Background: Community-based management of severe acute malnutrition has been widely rolled out and integrated to the existing health care system in Ethiopia. But there is a dearth of information concerning the survival to recovery of severely acutely malnourished children after rolling out of the program to a health post level in the country. Objectives: To examine survival to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program in Southern Ethiopia. Method and materials: Institution based retrospective cohort study was conducted using a data available from Jan. 2011 to Jan. 2013 in twelve randomly selected health posts. A two population proportion formula was used to calculate a sample size of 374. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. Chi-square was used to measure associations between categorical variables. The Mann-Whitney U test for the independent two samples test was used to compare the medians for non-normally distributed continuous variables. The outcome variable was time to recovery. The life table analysis and the Kaplan-Meier product limit were used to estimate the survival characteristics of the study subjects. And the log rank test was used to compare the survival curves. The Cox proportional-hazard regression model was used determine predictors of time to recovery. Result: A total of 348 patient cards were reviewed. The median time to recovery was 35 days and 49 days for children with kwashiorkor and marasmus respectively. It was significantly different (Log Rank=46.93, df=1 P<0.001). There was a 1.2% decrease in the likelihood of recovery for one month increase in age (AHR=0.988, (0.977, 0.999)). Children with marasmus were also 48% less likely to recover (AHR=0.517, 95% CI (0.386, 0.691)). Children who had a weight gain of >=3.21gm/Kg/d were 2.43 times (AHR=2.434, (1.828, 3.241)) more likely to recover. For a MUAC gain (mm/day) of one unit increase there was a 2.33 times (AHR=2.326, (1.373, 3.942)) increase in the likelihood of recovery. Conclusion: Being marasmic, age, weight and MUAC gain were identified as a predictor of recovery. Hence it needs special attention on counseling the care taker about the appropriate way of feeding the therapeutic diet to the sick child to improve weight and MUAC gain with due emphasis given to marasmic children.