School of Public Health

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    Acceptability and Associated Factors of Provider Initiated HIV Counselling and Testing among OPD Clients with Possible Clinical Sign of HIV Infection in West Arsi Zone, Ethiopia.
    (Addis Abeba University, 2011-05) Tesfaye, Tsegaye; Dr. Addissie, Adamu (MD, MPH, MA)
    Introduction: HIV counseling and testing is a gateway to prevention, treatment, care and support services and an essential tool in the control of HIV/AIDS epidemic. Currently HIV status has been very low which cannot be achieved only through the traditional VCT alone and another alternative, routine HIV testing and counseling of patients, also called provider initiated HIV Counseling and testing is proposed. Objective: To assess the acceptability and associated factors of provider initiated HIV counseling and testing among OPD clients with possible clinical sign of HIV infection in West Arsi zone, Ethiopia. Methods: Facility based cross sectional study was conducted on outpatient department clients with possible clinical sign of HIV infection in 6 selected health facilities in West Arsi Zone, Ethiopia. The health facilities were selected randomly; study subjects who came to the health facilities were consecutively interviewed. Data collected by a pre-tested, structured interview questionnaire. Regression model was used to assess factors associated with acceptability of provider initiated HIV Counseling and testing. Results: A total of 539 clients were interviewed with a response rate of 92.3%. The majorities (66.4%) were married, major age distribution was range from 25-29 (29.1%) and the main religion was Muslim (66.2%). Knowledge on importance of provider initiated HIV Counseling and testing was low. The willingness and overall acceptability rate was 86.5%, and 83.1% respectively. The major perceived barriers for acceptability were mainly thinking self as not being at risk, followed by fear of stigma and discrimination. On adjusted covariates of acceptability, acceptability of PIHCT was found to be associated with having information on PIHCT service (OR=0.36; CI=0.22-0.60), less and much support for PIHCT (OR=0.30; CI=0.11-0.85 and OR=0.31; CI=0.12-0.77) and tested for HIV before (OR=0.20; CI=0.10-0.41) Conclusion and Recommendations: The acceptability noticed in this study is high. The major perceived barriers for acceptability was thinking self as not being at risk. Having information on PIHCT service, tested for HIV before, and extent of support for PIHCT were found to be important predictors of acceptability of PIHCT. Hence, intensive IEC/BCC and promotional activities through different means should be in place to raise level of awareness, support and routine testing to facilitate its acceptability and reduce major barriers that affect PIHCT service utilization at all level.
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    Acceptability of cervical cancer screening using See and Treat (SAT) approachand determinant factors among women of reproductive age in health centers in Addis Ababa, Ethiopia.
    (2017-10) Bejiga, Birra; Ahimed(Professor), Ali
    Background: Cervical cancer is one of the leading causes of morbidity and mortality amongst female cancer worldwide, especially in developingcountries, including Ethiopia. The level of women’s acceptance of cervical cancer screening and treatment service is low and not well documented in Ethiopia. The current study sought to assess women’s acceptance about cervical cancer screening and determinant factors of the service. Objective: The objective of this study was to assess the acceptability of cervical cancer screening and treatment of precancerous cervical lesions and determinant factors among Women aged 30–49 years at selected health centers in Addis Ababa, Ethiopia. Methodology: A facility based cross sectional study which contain quantitative and qualitative methods were conducted at 14 public health centers in Addis Ababa, from November, 2016 to October 2017.Totally a sample of 316 women aged 30–49 years were taken for Quantitative study and a single stage simple random sampling technique was employed to address the study subjects. For the Qualitative part 12 health professionals who were providing the service were interviewed purposively. Acceptability of cervical cancer screening and treatment service was measured after the women underwent the procedure, using women’s Satisfaction on service delivered.Descriptive, Binary and multiple logistic regressions were employed to determine factors associated with acceptance about cervical cancer screening and treatment service.The transcribed and translated qualitative data was coded using cut and paste method of similar item. Then finally the codes were categorized and thematically described. Result: one hundred forty seven (47%) of the participants accepted cervical cancer screening and treatment service. Almost half (48.6%) of the participant were not knowledgeable. After adjusting for covariates, acceptance of cervical cancer screening and treatment service was positively associated with being governmental employee [(AOR=5.85, 95% C.I:5.85(1.7, 20.0)], women who had history of vaginal burning [(AOR=4.57, 95% C.I:4.57(1.417,14.76)], information about status of women [ (AOR = 0.06,95% CI: (0.014,0.26)], Delay screening and treatment time [(AOR = 7.6,95% CI: 7.6(2.89,20)], happy with staff behavior,[(AOR =4.6, 95% CI: 4.6(1.1,19.77)], health education about the service [(AOR = 2.45, 95% CI: 2.45(1.049,5.74)] , and women who were happy with setup of examination room [(AOR = 3.96, 95% CI: 3.96(1.32,20.85)] respectively. Conclusion and Recommendation: This study shows a suboptimal acceptance of cervical cancer screening and treatment services. Occupational status, test related problem, Lack of health education, Delay screening and treatment time, setup of examination room and staff behavior were found to be important determinants. Efforts are needed to increase women’s acceptance and knowledge about the service. Organization working on cervical cancer should establish a separate service delivery on screening and treatment program and should highly enhancehealth education and awareness creation program.
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    Acceptance of Index Case HIV Testing and Counseling among HIV Patients under Ossa Care and Support Outlets and Zewditu Memorial Hospital, Addis Ababa
    (Addis Abeba University, 2013-09) Abraham, Haileyesus; Mitike, Getnet (PhD)
    Background: HIV Counseling and Testing is one of the effective means for prevention of the spread of HIV infection. Partners and family members of PLHIVs are at higher risk for HIV infection. Thus, studying the acceptance of index case HTC and disclosure is important to improve the service. Objectives: This study aims to identify barriers to disclose HIV status by index clients and factors predict the acceptance of ICHTC. Methods: A cross-sectional study was conducted in Zewditu Memorial hospital and OSSA care and support outlet. A facility based systematic random sampling was followed to select 452 HIV positive individuals. Descriptive and inferential stastics wre usedto assess factors associated with acceptance of index case HTC and disclosure of HIV sero status. Result፡ The level of disclosure to main sexual partner was 56%. PLHIVs who had no sexual partner than spouse [OR: 8.15; 95% CI, 2.06-32.19] and had positive attitude to index case HTC [OR: 2.55; 95% CI, 1.63-4.0] were more likely to disclose their status. Index clients whose family and partner accepted HTC were 64% and 73%, respectively. Disclosure of status to family [OR: 2.40; 95% CI, 1.54-3.74] and friends [OR: 2.06; 95% CI, 1.19-3.57], being knowledgable [OR: 2.19; 95% CI, 1.39-3.44] and non-regular partnership [OR: 3.86; 95% CI, 1.68-8.83] were positively associated with acceptance of ICHTC. Nondisclosure to main sexual partner was protective to acceptance HTC. Conclusion and recommendation: Disclosure of self status, positive attitude to HTC, initiation for testng and being knowledgeable were factors influenced acceptance of HTC. Poor knowledge on HIV and risk assessment and negative attitude to ICHTC were barriers to disclosure. Intervention should prioritize mutual disclosure of HIV status, make clear understanding on HIV and its risks, benefits of ICHTC and develop positive attitude to ICHTC.
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    Adequecy of Energy and Nutrient intake among Children aged 6-23 Months in Southern Ethiopia
    (Addis Abeba Universty, 2016-03) Bedada, Beshadu; Hagos, Seifu(PhD)
    Background In Ethiopia child malnutrition is the major public health problem as 44% and 10% of children under age five years were stunted and wasted respectively. Intake of complimentary food with inadequate energy and micronutrient density coupeled with inappriopriate child feeding practice remain common problem in Ethiopian infant and young child feeding. Despite the fact that there are number of studies indicating high burden of malnutrition in Ethiopia, energy and nutrient adequacy of complementary foods has not been well studied. Therefore this study is designed to assess the dietary adequacy of energy and micronutrients in complementary foods of children aged 6 -23 months. Objective: To determine the adequacy of energy and nutrient intakes among children aged 6-23 months. Methodology A community based cross sectional study was conducted in Southern Ethiopia from February to March 2016. The samples were selected using simple random sampling method. Data on foods and drinks consumed by children aged 6 – 23 months in the previous 24 hours before interview was collected using repeated multiple pass 24-hour dietary recall method. Nutrient content of food was calculated using food processor (version 8.1). Adequecy of nutrient intake and nutrient density were analysed using STATA 12.1. Prevalence of inadequacy was estimated using IMAPP 1.0. Skewness and kurtosis test were made to test normality of continuous variable. Descriptive statistics was carried out to characterize the study population. Result: One hundred ninety (n=190) mother or care givers of children aged 6 -23 months participated. Grain, roots and tubers were consumed by most of the children (94.68%). Vitamin A rich fruits and vegetable consumed by 71 (37.8%) children. Median protein intake exceed recommended intake for children aged 6 – 11 months and was below recommended intake for children aged 11 -23 months. Median intake of energy from complementary food was below the WHO recommendation for children aged 6 -23 months. Median intakes of micronutrients from complementary food were below the WHO recommendation for children aged 6 – 8 months. For children aged 9 – 11 and 12 -23 months median micronutrient intake from complimentary food were below the requirement except for vitamin B2 and vitamin B6. VII Conclusion: Protein intake from complimentary food was adequate for children aged 6 -11 months old. Energy intake from complimentary food was inadequate for children aged 6 -23 months. Micronutrient intake from complimentary food was inadequate except vitamin B2 and vitamin B6 intake were adequate were adequate for children aged 9 - 23 months. Recommendation: In food inscured area such as this, to enure adequate intake of macro and micro nutrient, nutritional counseling complmented with supplementation of may be needed. Key word inadequate intake, nutrient, energy, children 6-23 month
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    Adherence to Antiretroviral Therapy in Currently Changed Treatment Guideline on People living with HIV/AIDS at Bishofitu Hospital, East Shoa, 2011. Ethiopa
    (Addis Abeba Universty, 2011-01) W/Tsadik, Asegid; Work, Alemayehu(PhD)
    Background: Adherence to antiretroviral therapy (ART) is crucial to ensure viral suppression, decrease the risk of disease progression and drug resistance. Non-adherence to ART, likewise, is common in all groups of treated individuals & lack of strict adherence to ART is considered to be one of the key challenges to AIDS care worldwide. Objective: To assess adherence to ART on currently changed guideline and factors associated with it among People Living with HIV/AIDS (PLWHA) attending ART unit at Bishofitu Hospital. Method: A cross sectional survey of 317 clients attending for ART at Bishofitu Hospital was carried out using both quantitative & qualitative design method. Using a structured and pre-tested questionnaire, data on drug adherence and other variables was collected through in-depth interview, peer educators FGD, patient’s self report (interview), pill count and by reviewing their clinical records. The nurse & ART Clinician who are working in the ART unit were involved in data collection after being trained. Ethical clearance was obtained from concerned bodies and consent was sought from the study subjects. Adherence is defined as the number of doses taken divided by the number of doses prescribed over a given period. It is considered as good if the patient took ≥ 95% of the prescribed doses correctly. Odds ratio was done to determine the strength of association for different variables. Major Findings The overall prevalence of HAART adherence was found to be, 398(95.4%) in this study. The highest proportion, 61 % of patients missed or delayed their doses due to simply forgetting & 47.4% due to being away from home & 29.4% being too busy. Independent positive predictors of HAART non adherence reported in this study comprise:-the participants who had: PLWHA’s residency far from Bishofitu hospital (>47 KM.), depression feelings , ART eligibility knowledge, medication adverse effect, history active substance uses, no adequate social support & one or two children under their care in the final adjusted multivariate analysis. Conclusions & Recommendations: The prevalence of ART adherence among clients using currently changed single combined fixed dose in this study was found higher than most studies done in developed countries & even much higher than the findings of other studies in Ethiopia. From these, we can infer that single & simplified ART has reduced the pill burden & helped the clients to take it at ease & this has increased the level of adherence behavior of clients, therefore continuous effort should be made to increase clients’ awareness to maintain the best level of adherence outcomes
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    Adherence to Antiretroviral Therapy in Currently Changed Treatment Guideline on People Living with HIV/AIDS at Bishofitu Hospital, East Shoa, 2011. Ethiopa.
    (Addis Abeba Universty, 2011-01) W/tsadik, Asegid; Worku, Alemayehu(PhD)
    Background: Adherence to antiretroviral therapy (ART) is crucial to ensure viral suppression, decrease the risk of disease progression and drug resistance. Non-adherence to ART, likewise, is common in all groups of treated individuals & lack of strict adherence to ART is considered to be one of the key challenges to AIDS care worldwide. Objective: To assess adherence to ART on currently changed guideline and factors associated with it among People Living with HIV/AIDS (PLWHA) attending ART unit at Bishofitu Hospital. Method: A cross sectional survey of 317 clients attending for ART at Bishofitu Hospital was carried out using both quantitative & qualitative design method. Using a structured and pre-tested questionnaire, data on drug adherence and other variables was collected through in-depth interview, peer educators FGD, patient’s self report (interview), pill count and by reviewing their clinical records. The nurse & ART Clinician who are working in the ART unit were involved in data collection after being trained. Ethical clearance was obtained from concerned bodies and consent was sought from the study subjects. Adherence is defined as the number of doses taken divided by the number of doses prescribed over a given period. It is considered as good if the patient took ≥ 95% of the prescribed doses correctly. Odds ratio was done to determine the strength of association for different variables. Major Findings The overall prevalence of HAART adherence was found to be, 398(95.4%) in this study. The highest proportion, 61 % of patients missed or delayed their doses due to simply forgetting & 47.4% due to being away from home & 29.4% being too busy. Independent positive predictors of HAART non adherence reported in this study comprise:-the participants who had: PLWHA’s residency far from Bishofitu hospital (>47 KM.), depression feelings , ART eligibility knowledge, medication adverse effect, history active substance uses, no adequate social support & one or two children under their care in the final adjusted multivariate analysis. Conclusions & Recommendations: The prevalence of ART adherence among clients using currently changed single combined fixed dose in this study was found higher than most studies done in developed countries & even much higher than the findings of other studies in Ethiopia. From these, we can infer that single & simplified ART has reduced the pill burden & helped the clients to take it at ease & this has increased the level of adherence behavior of clients, therefore continuous effort should be made to increase clients’ awareness to maintain the best level of adherence outcomes.
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    Adherence to Highly Active Antiretroviral Therapy and its Associated factors among HIV Infected Adolescents in Addis Ababa, Ethiopia
    (Addis Abeba University, 2014-06) Firdu, Naod; Dr. Enquoselassie, Fikre(PhD); Dr. Jerene, Degu(MD, PhD)
    Background: For antiretroviral therapy (ART)to work effectively, adherence is very crucial. However, most of the studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents. Since the physical, biological and behavioral changes which occur during adolescence could affect ART adherence, we endeavored to assess the level of adherence among adolescents treated at three hospitals in Addis Ababa, Ethiopia. Study Objective: This study was carried out to assess the magnitude of ART adherence among HIV infected adolescents in Addis Ababa, Ethiopia. It also looked into the various sociodemographic, behavioral and clinical factors associated with ART adherence among adolescents. Study Methods: Using a cross-sectional study design, 273 HIV infected adolescents receiving ART were interviewed from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports among randomly selected adolescents aged 13-19 years. Data was entered using Epi Info version 3.5.4 and exported to SPSS version 21 for analysis. Bivariate and multivariate methods were used for analysis. Results: We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%)of the participants were female. Their mean age was 15.42 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). Most (96%)were on first line antiretroviral drugs. The median duration on ART was 7 years (IQR, 3). On Bivariate analysis; WHO stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART and having special instructions for ART medications were associated with optimum adherence. However only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 CI, 0.124-0.97)and adolescents with widowed parent (Adjusted OR, 0.087 with CI, 0.021-0.359) were significantly associated with optimum adolescent ART adherence. Conclusions: The level of self-reported ART adherence among HIV infected adolescents at the three hospitals was below the recommended threshold. Being in advanced WHO clinical stage was associated with better adherence levels, but history of taking CPT was associated with poorer adherence. Earlier presentation of adolescents to care should be encouraged, but more targeted adherence support should be planned for those who present at early stage of their illness.
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    Adherence to Option B+ and Associated factors among Pregnant women on Pmtct Services at Public Health facilities of East Shawa Zone, Oromia, Ethiopia
    (Addis Abeba Universty, 2017-05) Tarekegn, Mihretu; Seme, Asefa (PhD)
    Background: Anti-retroviral therapy has made a significant reduction in morbidity and mortality related to HIV/AIDS. However, it cannot be fully realized without addressing barriers related to retention in care and medication adherence. The roll out of simplified Option B+ was launched in Ethiopia in 2013 with the aim of eliminating new HIV infection in children in 2015 and to keep the mother alive. Objective: To assess levels of option B+ adherence and associated factors among pregnant women on PMTCT follow-up at public health facilities of the East Shawa zone, Ethiopia Methods and materials: The study was conducted in public hospitals and health centers in East Shawa zone from January to June 2017. A descriptive cross-sectional study design was implemented to select 304 pregnant women using a systematic random sampling method. Data were collected using a structured and pre-tested questionnaire; the collected data were cleaned and entered into SPSS Version 21 for analysis. Multivariate logistic regression was used to determine association between independent and dependent variables. Result: Two hundred ninety-three pregnant women who were on option B+ participated in the study. The mean ages and standard deviation of the participants were 29.2 ± 4.6. The overall ART adherence of pregnant women on ART medications was 82.6%. The study showed that participants educational status, AOR 4.54(95% CI; 1.72-11.95), participants status disclosure 2.61(95% CI; 1.01-6.71), social and financial support to the participants AOR 2.76(95% CI; 1.17-6.51), counseling on the benefit AOR 2.9(95% CI; 1.27-6.63), were all positively and significantly associated with adherence to option B+ treatment while experience of drug side effect AOR 0.24(95% CI; 0.1-0.6), and fear of stigma and discrimination AOR 15.79(95% CI; 4.64-53.67), were negatively associated with adherence to option B+ treatment. Conclusion and recommendation: While education, counseling on health benefit of treatment for the fetus and the mothers, social and financial support favors adherence, Fear of stigma and discrimination and drug side effects effect negatively affect adherences to option B+ among pregnant women attending PMTCT in public health facilities. The investigator recommends collaborative work among patients, healthcare professionals, and public to enhance ART adherences Key word: HIV, ART, Option B+, Adherence, pregnant women, Ethiopia
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    Adoption of Electronic Medical Records among Health Professionals at Public Hospitals in Addis Ababa City Administration Health Bureau, Ethiopia.
    (Addis Ababa University, 2012-12) Gebremariam, Semere; Lamenew, Workshet(MSc); Deyassa, Negussie(PhD)
    INTRODUCTION:Wellness and health are central to live of all people of age group. Incorporating information communication like Electronic Medical Records on the health care industries is mandatory for the better improvement of patient care and safety, integrated research, for effective planning,monitoring and evaluation of disease etc. Electronic Medical Record implementation in public hospitals in Addis Ababa is on the infant stage not more than three years since its inception.Even though There is discrepancy in adoption among health professionals and is not utilized as needed due to different factors,most of the public hospitals have implemented it.So identifying the factors which affect the adoptionwill help to apply proactive measure and correction so as to increase the adoption of EMR among health professionals whom are working at the public hospitals. OBJECTIVE:This study aimed at identifying the factors that affect the Behavioral Intention and usage behavior of Electronic Medical Record and determine the utilization status among health professionals working in public hospital in Addis Ababa City Administration health Bureau. METHOD: A Cross-sectional survey was carried out among health professionals working at public hospitals in Addis Ababa using modified theory of unified acceptance and use of technology(UTAUT)model. Four hundred eight health professionals who had training on EMR were interviewed at the five public hospitals. RESULTS:The utilization of EMR among health professions working at the public hospitals was 51.7%permanence expectancy, Effort expectancy, social influence were factors influencing the behavioral intention of health professionals to adopt EMR and Behavioral intention was also significant influencing factor on actual usage behavior. Facilitating condition remains insignificant on the actual usage behavior of EMR among health professionals. CONCLUSION AND RECOMMENDATION:The utilization rate of EMR was 51.7%: Having no experience,misunderstanding on the relative advantage, perceiving complexity of the system, inadequate support of the top managers, low behavioral intent were factors associated with the behavioral intention and actual usage of EMR. This study indicates that the necessity of integrating health management information system with the daily health care activities and development of health information policy that can scale the utilization rate.
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    Adult patient satisfaction with nursing care
    (Addis Abeba Universty, 2005-06) Chaka, Bekele; Davey, Gail (PhD)
    Background: - Patients have the right to expect Quality of care. Patient satisfaction with nursing care is considered an important factor in explaining patients' perceptions of service quality. Care assessed to be high quality according to clinical, economic or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. There is, then, a sound rationale for making the organization and delivery of health care responsive to consumer opinion. Objective: -The objective of this study is to assess quality of nursing care as indicated by patients’ satisfaction. Methods: - A Cross-Sectional Survey was conducted at Public Hospitals in Addis Ababa, namely Tikur Anbessa, Saint Paul and Zewditu Memorial Hospitals from July, 2004 to April, 2005. The study population was adult patients who were admitted into the medical, surgical and gynecological wards of study Hospitals for at least two nights. The data collection tool was a modified ‘Newcastle Satisfaction with Nursing Scale’ (NSNS). Data analysis was computed by SPSS. Ethical clearance was secured from Addis Ababa University, Medical faculty and from the study Hospitals. Participation in this study was voluntary and based on patient’s ability to give informed consent. Result: - A total of 660 adult patients from medical, surgical and gynecological wards were approached from the study hospitals and 631 of them participated in this study (Non-response ii i rate was 4.4%).Participants who were females, age group 41 – 50 years of old, having low income, less educated, patients who were admitted in third classes, and have no history of previous admission were more satisfied. The over all rating of satisfaction was 67%.The top aspects that patients scored highest for their satisfaction with nursing care were the amount of freedom given, nurses capability in their work and nurses treatment of patients as an individual. The aspects with which patients were least satisfied were the amount and type of information they received regarding their condition and treatment and also the amount nurses knew about patients’ care. Age was the significant predictor of patient satisfaction with nursing care (p<0.05). The need of improving interpersonal relation ship of nurses with their patients was recommended. KEYWORDS: -Nursing care, Patients’ satisfaction, Quality
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    Aflatoxin exposure and its association with stunting among young children in Butajira district, South-Cental Ethiopia
    (Addis Ababa Universty, 2018-10) Ayele, Mary; Shikur, Bilal (MD, MPH)
    Background: Aflatoxins are one family of mycotoxins, which are a naturally occurring toxic by-product. Aflatoxin M1 is the major metabolite product of aflatoxin B1, which is excreted in urine of mammals and gives a reliable indication of recent (24-72 hours) exposure to aflatoxin. Recent evidences suggest several mechanisms through which aflatoxin can impair growth & development. Despite the high prevalence of stunting in Ethiopia, there is no well-established evidence showing individual aflatoxin exposure and its association with stunting in young children Objective: The study assessed aflatoxin exposure and its association with stunting among young children aged 12 to 59 month in Butajira district. Method: A community based cross-sectional study was conducted in Health and Demographic Surveillance Site, Butajira. We used stratified simple random sampling technique to select the study participants. The study included, 332 children aged 12-59 month. The data were collected in the form of questionnaire, height/length measurement and urine samples collection. Aflatoxin M1 analysis was performed by Enzyme-Linked Immunosorbent assay (ELISA) at Ethiopian Public Health Institute laboratory. The data analysis was carried out using STATA and WHO Antro plus. Multiple logistic regression was used to see the association between stunting and aflatoxin exposure level by adjusting for possible confounders. Results: The mean age of children participated in the study was 39+10.9 month. About 62% of the children were exposed to aflatoxin M1 in their urine, at a level ranging from 0.15ng/ml to 0.4ng/ml. Sixty point nine percent (60.9%) of the study participants were stunted. Children with detectable aflatoxin M1 in their urine at a level of 0.4ng/ml were 1.9 times (95% CI: 0.79, 4.46) more likely to develop stunting than those who were not exposed, even though this association was not significant at p-value <0.05 and 95% CI. Conclusion and Recommendation: The study showed a high prevalence of aflatoxin exposure in the study area. This indicates that strategies and regulations focusing mainly on crop management system and food safety measures need to be revised in order to take in to account the measures for control of aflatoxin exposure.
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    Age at first Sexual Debut and Condom Use among in School youth in Debre Markos Town, Amhara Region, Ethiopia
    (Addis Abeba Universty, 2013-01) Dagne, Behailu; Mekonnen, Wubegzier(PhD)
    Background: Early initiation of sexual activity has been escalating among young people.and it leads to risky sexual behaviors. This might lead to health and health related burden among youth. In order to prevent this problem as well as to implement youth reproductive health (RH) programs effectively conducting different reasearches is necessary. Objective: To assess the age of first sexual debut and condom use among in school youth in Debre Markos town Method: A cross sectional study was employed in Debre Markos town from December, 2013 to December, 2014. The study populations were secondary school students in the town. Seven hundred students were selected from three secondary schools. Self administered structured questionnaire and in depth interview was a method used to collect data. Data entered into EPI-info software and analyzed using the SPSS statistical package. Descriptive statistics, Chi square test, bivariate and multivariate logistic regressions were used. Result: About a fifth (22.3%) of study participants started sexual intercourse at the time of the study. The median age at first sexual intercourse was 16. Socio-demographic factors such as being grade nine (AOR =5.5: 95%CI (1.2, 25.6), living with renting alone AOR=1.7:95%CI (1.2, 17.6) and getting less than 100 birr/month pocket money AOR=5.1:95%CI(1.1,26.0)were significantly associated with early sexual activity. Similarly, students who did not hear about the negative effect of early sexual activity AOR=3. 5:95%CI (1.1, 11.2) and who did not agree with the idea of their parental connection and supervision might postpone sex AOR=3.5:95% CI (1.1, 10.7) significantly associated with early sexual debut. Majority 109 (69.9%) did not use any family planning method including condom at the time of their first sexual intercourse. Those who planned their first sexual intercourse (36.5%) and who had willingness to get condom themselves (36.8%) used condom more than their counterparts. Those who got more than 200 Birr per month pocket money (AOR=5.7: 95%CI (1.1, 29.9) were used condom more at last sexual intercourse. Among student’s community norms, lack of comprehensive knowledge and misconception about condom is a reason not using condom during sex Conclusion: Age of sexul debut among high school students was low in the town. Students’ knowledge about early sexual activity influence to start sex at earlier age. Parental connection and supervision has a role to start sex at earliy age.Use of condom or other family planning method at first sexual intercourse among student was low. Students who are not willing to get condom themselves used condom lower than others. Recommendation: In order to decrease early sexual activity, equip students with comprehensive sexual health knowledge is a crucial work. This could be done by the collaboration of family, governmental and non governmental organizations. Condom use at sex might be increased by improving their willingness to get condom themselves. Awareness creation in the community and avoiding misconception could be a a strategy.
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    Agreement and Concordance Regarding Fertility Intention and Family Planning Utilization Between Married Couples in Dukem Town,Oromia Special Zone.
    (Addis Abeba Universty, 2011-05) Wegi, Chala; Fantahun, Mesganaw(PhD)
    Background Traditionally, women have been the main respondents for the most of knowledge, attitude and practice survey related to family planning, contraceptive prevalence, demographic and health surveys and the like. The role of men has been limited especially in Africa where as men are the primary decision-makers of most reproductive issues including family planning. However, it has been now realized that programs that exclusively focus on either men or women may fail because most sexual, family planning, and child bearing decision are made or may potentially be able to be made by both partners together. Thus it is important to interview both husband and wives when ascertaining family planning attitudes and most other reproductive health research. Objective To assess the level of agreement and concordance regarding fertility intention and contraceptive use between married couples. Methodology A community based cross sectional survey was conducted on 422 married couple‟s in Dukem town which were selected by using systematic random sampling method. Both quantitative and qualitative method was employed. Data pertaining to fertility intentions and contraception was collected and the level of agreement (kappa statistics) between husbands and wives was computed. Result The observed concordance was 71.6% for ideal family size, 94.9% for contraceptive attitude, 95.9% for fertility desire, and 99.7% for report of number of currently living children. The unadjusted kappa statistic varied from a relatively low of 0.61(p<=0.000) for contraceptive attitude to high of 0.99(P<=0.000) for number of living children, for ideal family size 0.63(P<=0.000), fertility desire 0.91(P<=0.000), ever use of contraceptive 0.84(P<=0.000) and current use of contraceptive 0.87(P<=0.000) having kappa values in between. Overall greater degree of agreement was observed for reproductive health events as compared to family planning attitudes and intentions. Conclusion Overall, a greater degree of agreement was observed for reproductive health events as compared to family planning attitudes and intentions. The latter are more subjective outcomes and can be expected to vary among spouses. Thus, we can infer that for reproductive health events, wives responses can be taken as proxy for the couple‟s response but for family planning attitudes and intentions there is a need to collect information both from husbands and wives.
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    Agreements between radiological and histo-Pathologic Diagnosis of Cases on Pre-op neuro radiology Session
    (Addis Ababa Universty, 2017-10) Jemal, Abera (Phd); Mekonnen, Abebe (Phd)
    Introduction:Intracranial and spinal mass lesions are an important cause of neurological morbidity and common indication for cross sectional imaging. Given the wide range of pathological cases that can present as intra cranial mass lesions, the radiologist has an important role in limiting the differential diagnosis in clinical decision making process and in further management of cases. so far there are few reports on radiological and histological and pathology correlation done in Ethiopia and no report done giving emphasis on cases discussed on inter-departmental management session ; like , pre-operative Neurosurgery and radiological session. Thus, this research contribute the knowledge of the imaging appearance of various intracranial tumors and subsequently to improve the diagnostic accuracy and role of radiology in the management decision . Objectives:To assess the correlation of preoperative radiological diagnosis of lesions with histological diagnosis in TikurAnbesahospital , Addis Abebea , Ethiopia , from January 2016 to August 2017 G.C. Methods:Hospital based prospective cross- sectional study was conducted on 78 patients who underwent surgery for the intra-cranial and spinal lesions at TikurAnbessa Specialized Hospital in a period of 21 months from January 2016 to August 2017 G.C. Patients included here are those who had either CT or MRI or both report with confirmed histopathology result. Result:There was morethan 80 % of concordance between pre operative radiologic diagnosis and histological diagnosis based on based on top diagnosis and first differential diagnosis given on neuro- radiology and neurosurgery joint session discussion in imaging evaluation of Glial tumor , Menigioma and Sellar/Parasellarregin tumors. Conclusion:Glial tumor and Meningioma were the most frequent intracranial tumors presented. It was seen that pre operative radiologic diagnosis accuracy was high for most of intracranial tumor.
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    Air Pollution in Ethiopia: Indoor air Pollution in a Rural Butajira and Traffic air Pollution in Addis Ababa
    (Addis Abeba Universty, 2009-06) Kumie, Abera; Berhane, Yemane
    Background About half of the global population and over 70% of countries in the Sub-Saharan Africa rely on biomass fuel as a source of household energy. Over 95% of households in Ethiopia use biomass fuel for cooking. Despite the prevailing major concerns among policy makers and professionals on air pollution, the magnitude of air pollution from domestic and traffic sources in Ethiopia is not well established. Objectives This thesis attempted to examine the magnitude of air pollution by measuring 24-hr concentrations of indoor nitrogen dioxide in rural Butajira and daily measurement of ambient carbon monoxide in traffic congested areas of Addis Ababa. Materials and Methods A longitudinal study was conducted to assess the indoor air pollution component between March 2000 and April 2002. Concentrations of NO2 were measured cross-sectionally at about threemonth interval using a modified Willems badge air samplers. Mothers of children in households were interviewed within 24 hours of air sampling about characteristics of fire use, type of fuel and cooking pattern. A Saltzman colorimetric method using a spectrometer calibrated at 540 nm was used to analyze the mass of NO2 in field samples. Roadside traffic air pollution was assessed using portable CO USB data loggers. CO monitor is small electronic equipment installed along 40 roadside sampling points to continuously measure and record CO concentrations at an average interval of 10 seconds for about 10 hours in the daytime. Four on-road traffic light posts were also included to explore the association with the results of roadside CO concentrations. Data were entered and analyzed using EPI INFO version 6.02 statistical software. SPSS version 15.0 was further used to run regression analysis. Data from CO logger were downloaded in Excel format. Summary statistics, graphs, charts, and tables were the main tools used to present findings. One-way ANOVA, multiple regression analysis and linear mixed model analysis were also used to sort out any non-random differences in NO2 and factors affecting the levels of NO2. viii Results Wood, crop residues and animal dung were the main fuels in rural households in the study area. The mean 24-hr concentration of NO2 was 97.3 μg/m3 (95% CI: 95.9, 98.6). The median (IQR) was 68.4 (98.7) μg/m3. Ecology and season have shown differences in the mean concentration of NO2. Households in the highland areas and during wet season had higher indoor NO2 concentration. Biomass fuel type, ecology, purpose of fire use, cooking of at least one type of food in a day, and frequency of fire use were important household variables to explain the variations in the daily NO2 concentration. While ecology was the major predictor, housing physical structures showed little influence on the variation of indoor NO2. In Addis Ababa, the 15-minute mean (+SD) CO concentrations were 2.03 (1.94) and 2.64 (2.53) ppm respectively observed during the wet and dry seasons of 2007 and 2008. The two means did not vary significantly. There were variations in average CO by time and location of sampling. CO tended to be high in early mornings and in the afternoon rash hours. The CO profiles between roadside and on-traffic post light were, however, not different from each other. Conclusions and Recommendations About 70% of NO2 Key words: magnitude, NO indoor measurements were more than double the currently proposed annual mean of WHO air quality guideline. Ecology and fire-fuel use household characteristics were important determinants of indoor air pollution. Although average CO concentrations were below the US-EPA and WHO ambient air quality guidelines, there is a strong indication that CO concentrations will exceed or approach these guidelines shortly. Further studies in the description of burden of diseases attributed to indoor air pollution are highly recommended. Interventions targeting at improving the design and utilization of fuelstove efficiency and ventilation are essential. The measurement of traffic particulate matter in high traffic areas is suggested given the high proportion of on-road diesel-engined vehicles in Addis Ababa. 2, indoor air pollution, agro-ecology, sources, biomass fuel, variation, Addis Ababa, CO, traffic air pollution, Ethiopia.
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    Alcohol use and associated factors during pregnancy at Kolfe Keraniyo sub city in Addis Ababa, Ethiopia, 2017
    (Addis Ababa Universty, 2018-01) Fekade, Maereg; Getachew, Sefonias (Mph, Phd Fellow)
    Background: The use of alcohol is increasing from time to time in all segments of demographics and has become one of the rising major public health and socioeconomic problems worldwide. Alcohol use during pregnancy is associated with significant risks to the unborn child and can contribute to prenatal complications. In Ethiopia, there is expansion of alcohol use and have reached to women in their fertile age that include pregnant woman. Objectives: The main objective of this study was to assess the magnitude and associated factors of alcohol use during pregnancy in Kolfe sub city. Methods: Institutional based cross sectional study was conducted from April to June, 2017 in Addis Ababa, Ethiopia. A total of 380 pregnant women were selected by using systematic random sampling and included in the study. Data was collected using questionnaire. The collected data was coded and entered in the computer using Epi Data version 3.1 and the data was analyzed using SPSS for window version 20. Descriptive statistics such as frequency, proportions, means, medians and standard deviations were calculated. A binary logistic regression model was used to identify associated factors for alcohol use among pregnant women. The results were described using adjusted odds ratio with 95% confidence interval and statistical significant was considered at p value < 0.05. Results: This study revealed that the overall prevalence of alcohol use among pregnant women was found to be 39.8%. The factors like not having formal education[AOR 95% CI=8.47(2.42, 29.62), having primary education [AOR 95% CI= 4.26(1.23, 14.74), being housewife[AOR 95% CI= 4.18(2.13,8.22), unplanned pregnancy [AOR 95% CI=2.47(1.33, 4.60), having history of abortion[AOR 95% CI=3.33(1.33, 6.05)], not having awareness on the effect of alcohol on the fetus[AOR 95% CI=4.66(2.53,8.61)], and not having family social support [AOR 95% CI= 2(1.14,3.53) were found to be significantly associated with alcohol use among pregnant women. Conclusions and Recommendations: the study found high level of alcohol use by pregnant women at Kolfe sub city. Not having education, having primary education, being housewife, unplanned pregnancy, having history of abortion, not having awareness on the effect of alcohol on the fetus, and not having family social support are found to be predictors of alcohol use. Factors associated with alcohol use during pregnancy are essential to reduce alcohol use and its health effect.
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    Alcohol Use Disorder, Help-seeking Behavior and the Impact of a Brief Alcohol Intervention in Sodo District,Gurage Zone, South-central Ethiopia.
    (Addis Abeba University, 2021-06) Zewdu, Selamawit(Phd); Teferra, Solomon(MD, PHD); Hanlon, Charlotte(MD,PhD)
    Background: Alcohol use disorder (AUD) is disabling yet neglected and frequently left untreated in low- and middle-income countries (LMICs). To increase the treatment rate, AUD services need to be integrated into primary health care (PHC) units as people with the disorder often make contact with PHC due to physical health consequences of AUD. Objectives: 1) To determine the magnitude of AUD and associated disability, co-morbid depression, suicide, internalized stigma and help seeking behavior in Sodo district, Gurage Zone,South-Central Ethiopia. 2) To assess the impact of a brief intervention delivered at PHC on alcohol use after 12 months. 3) To explore the perspectives and experiences of people with AUD, caregivers and service providers about the brief intervention delivered at PHC in Sodo district. Methods: The study was nested within the PRogrammme for Improving Mental health carE(PRIME). Mixed quantitative and qualitative methods were used: 1) Using a cross-sectional house-to-house community survey of 1500 adults (aged 18 years and above) living in Sodo district. The prevalence of AUD help seeking behavior, barriers to care, disability, co-morbid depression, internalized stigma and suicidality were determined. AUD was assessed using a culturally adapted version of the Alcohol Use Disorders Identification Test (AUDIT), A Poisson working model with robust variance was used to determine prevalence ratios. 2) A pilot beforeand-after study was carried out among 49 people attending PHC facilities who had probable alcohol use disorder. Participants received an evidence-based single session brief intervention for AUD which was delivered by trained PHC workers. Follow-up assessment was conducted at 3 and 12 months. This included evaluation of AUD severity, functioning using World health organization disability assessment schedule (WHODAS 2) Score), consequences of drinking using Short Inventory of Problems revised version 2 (SIP-2R) and depression using the patient health questionnaire (PHQ-9). A mixed-effect linear model was used to assess the impact of the intervention at 3 and 12 months. 3) A nested qualitative study was conducted to explore perceptions and experience of service users, caregivers and service providers on the acceptability, impact and implementation of the intervention. Twenty-six in-depth interviews were conducted with 14 people with alcohol use disorder, four caregivers and eight health professionals who were providing the intervention. Framework analysis was used for analysis. Results: The prevalence of alcohol use disorder was 13.9% (25.8% in men and 2.4% in women).Alcohol used disorder was more prevalent among men (adjusted prevalence ratio (aPR) 7.7, 95% confidence interval (CI): 4.4, 13.1; farmers aPR 3.9, 95% CI: 1.0, 14.8), traders (aPR 6.0, 95% CI: 1.5, 23.9) and daily laborers (aPR 6.3, 95% CI: 1.5, 26.1) compared to housewives. A oneyear increase in age was associated with a 1% increase in the prevalence of AUD (aPR 1.01,95% CI: 1.00, 1.02). As the number of stressful events, depressive symptom score and disability score increase by one, the prevalence of AUD increased by 27% (aPR 1.2, 95% CI: (1.1, 1.3), 3.0 % (aPR 1.03, CI: 1.01, 1.03) and 2.0% (aPR 1.02, 95% CI: 1.01, 1.04), respectively. Having suicidal thoughts was also associated with AUD (aPR = 1.5; 95%CI: 1.1, 2.1). Of participants with an AUDIT score ≥16 (indicating harmful drinking), only 13% (n=6) sought help for alcohol problems, and 70.0% reported high internalized stigma. Major barriers to seeking help were: wanting to handle the problem on their own, believing that it would get better by itself, being unsure about where to go, not bothered by the problem, financial barriers, including being concerned about the cost of professional help, concerned about what people might think, and access. Forty-nine people with AUD received the brief intervention, and 92 % completed the assessments. Following the brief intervention, there was a statistically significant reduction in AUD severity, consequences of drinking and depressive symptoms. The adjusted mean difference (AMD) in AUDIT score at 3-months was -2.66 (95% CI -5.21, -0.11) and at 12 months was -4.15 (95% CI -6.76, -1.54). For SIP-2R score, AMD for AUDIT score was -2.52 (95% CI -4.86, -0.18) at 3-months and -3.00 (95% CI -5.87, -0.14) at 12-months. For PHQ-9 score AMD was -2.06 (95% CI -3.35, -0.77) at 3-months and -2.03 (95% CI -3.35, -0.72) at 12months. Although positive effects of the intervention on functioning were not seen in the quantitative analysis, the qualitative study strongly supported the impact of the intervention on improving functioning. People with AUD and caregivers reported improved work capacity,increasing earnings, less money wasted and, consequently, being able to better provide for their family. The brief alcohol intervention was accepted by most service users. Service providers reported low acceptability of their advice by participants, participants’ lack of openness to talk about alcohol, and shortage of space as barriers for implementation. Primary health care workers recommended further training, raising awareness of the community about alcohol use disorder, and working with the community and health extension workers. They also requested a stronger administrative support system for improving management of alcohol use disorder. Conclusions: Although alcohol use disorder was a common problem in the study setting, the unmet need for treatment was substantial. A pilot integration of a single session brief intervention in PHC had a positive impact on the severity of AUD, consequences of drinking,and depressive symptoms over a period of 12 months. The intervention was also feasible,acceptable and perceived to bring benefits. However, there is a need to address such issues as low community awareness about AUD, stigma, inadequate skills of PHC workers and engagement of the community in order to increase help-seeking behavior, and enhance acceptability and the impact of intervention in PHC settings. With more frequent supervision,non-specialized workers at the PHC level have the potential to contribute to the reduction of the burden of AUD through early screening, brief intervention, and referring people with severe AUD for specialist treatment.
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    Alcohol Use Prevalence and Associated factors among Secondary and Preparatory School Students in Mehal Meda, North Shoa Zone ,Ethiopia
    (Addis Abeba University, 2021-11) Ayegont, Belihu; Dr. Emyu, Solomon
    Back ground: Alcohol is one of the most psychoactive substances used by adolescent and youth. Alcohol use above the standard level and even if in the standard level leading different adolescent and young population public health problem. More than 200 health problem can occur due to alcohol use. Adolescence and youth age group are the most active population for decision making and begin alcohol use early. This study was conducted to address how much of the school age population use alcohol and what are the risk factor that leads to use alcohol in this study area. Objectives: Objective of this study was to assess alcohol use prevalence and its associated factors that lead to use alcohol among secondary and preparatory school students in Mehal Meda 2019/20. Methods: School based cross-sectional study design method was used among secondary and preparatory school student in MehalMeda, Ethiopia. 437 individuals were selected from a total of 9000 by making stratified by grade 9-10 and 11-12 and then further stratified each grade and lastly use simple random sampling to select the participant from each section from each grade. Structured self-administered questionnaire was used to collect data after using pre-test. Epi-Info version 7 was used to enter data and SPSS version 23 software was used to analyze data. Result: A total of 437 high school and preparatory school students were included in the study. Among those 253(57.9%)participants were male. 137(31.4%[27.05%-35.75%]) study participants were alcohol users. Multivariable logistic regression analysis showed that age from 19-22 years had association with alcohol use prevalence by odd ratio 3.01[1.01-44.2] . Conclusion: Relatively high alcohol users were found in high school and preparatory school students. There is a need for collaborated effort to reduce alcohol use prevalence like in school awareness creation in drama form, by forming different club, parent follow student and give advice and woreda education bureau by fencing the school, follow up the school teacher and exchange information about the status of the students.
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    Analysis of Spatiotemporal Dynamics and Associated Factors of Malaria: a Comparative Study Around Gilgel-Gibe Hydroelectric Dam and Control Villages, Jimma Zone, Southwest Ethiopia
    (Addis Abeba Universty, 2015-02) Sena, Lelisa; Ali, Ahmed (PhD)
    Background Analysis of spatiotemporal dynamics of malaria data of health care systems along with climatic variables and assessment of the intervention tools provides important insights into the changing malaria situation, which might guide adjustments of malaria program activities and priorities of malaria research topics. The objectives of this study were to compare trends of malaria, to ana-lyze spatiotemporal dynamics of malaria in the Gilgel Gibe Hydroelectric dam (GGHD) site, to examine the role of climatic variables on malaria, to determine possession and utilization of long lasting insecticidal nets (LLINs/ITNs), and to evaluate the prevalence of malaria around GGHD and a control site. Materials and methods Records of malaria cases over eight years period in health facilities of the two sites were re-viewed along climatic variables. Malaria episode and meteorological data were registered on excel spreadsheet separately. Summary of the data were exported to SPSS version 20 for Win-dows and linked together using unique identifiers. Prevalence of malaria was analyzed and de-scribed by person, place and time using line graphs. Spearman correlation coefficient was ana-lyzed to explore the correlation between climatic variables and malaria episodes. Malaria epi-sodes of the two sites was compared using odds ratios. Spatial analysis was carried out by linking malaria episodes data of GGHD site with the Gilgel Gibe Health and Demographic System (GGHD-HDSS) data that have been geo-referenced. Pois-son regression model was applied to estimate odds ratios of the malaria episodes among buffer zones and altitude ranges of the site using the STATA statistical software version 12. A household survey was conducted during peak malaria transmission season to assess possession and utiliza-tion of LLINS by households. Similarly, blood survey was conducted during the same season us-ing rapid diagnostic test (RDT). Both data of the household and blood surveys were entered into EpiData entry II database and exported to SPSS version 20 for Windows for analysis. Binary and multinomial logistic regressions were employed to identify predictors of LLIN ownership and uti-lization. xiv Results Two-third of the 163,918 registered malaria episodes were slide/RDT confirmed cases. Plasmo-dium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) accounted for 54.6% (60.4% in GGHD site and 52.3% in control site) and 41.6% (33.6 in GGHD site and 44.7% in control site), the rest (3.8%) was mixed species infections. P. falciparum and P. vivax were twice and nearly trice times more likely to occur in the control site compared to GGHD site. Several peaks of ma-laria transmission seasons were noted in the control site whereas only two small one main trans-mission peaks were observed in the GGHD. The probabilities of infections by both P. falciparum and P. vivax were high in the control site than in the GGHD site in all age categories. Children from 10 to 14 years were the most affected followed by children below the age of 10 years. In the GGHD site, 45.0% of the P. falciparum episodes were registered within one-kilometer ra-dius of the Dam. Yet, as distance increases from the GGHD, the odds of P. falciparum occur-rence increases significantly up to five kms, when adjusted for population density. Positive and significant correlation between P. falciparum occurrence and altitude was also noted. Again; as the distances from the GGHD increases, the occurrence of P. vivax increases. On the other hand, increasing altitude was negatively and significantly associated with the occurrence of P. vivax malaria. At the GGHD site, moderate correlations were seen at months 2 and 3 lags with both rainfall and relative humidity. There were only weak positive correlations at month 4 for rainfall and months 2 through 4 for relative humidity at the control site. The overall coverage of LLINS was 56.6% ( in GGHD site and control site). Higher number of HHs from GGHD site reported to have at least one LLINS (OR = 2.2 & P < 0.001) whereas high-er number of HHs from control site reported to have two or more LLINS (OR = 2.1 & P < 0.001). Factors that independently affect the possession and utilization of LLINS were found to be age of HH heads, HH RWI, accessibility to all weather roads, proximity to health facilities. From the total 2269-screened individuals, only 17 were tested positive for malaria. Since all the cases were from District based site, the prevalence in the site was 1.4% whereas it was zero in the site where the Community-based IRS was applied. xv Conclusions Malaria prevalence was higher in the control than the GGHD site. The present finding did not show evidence of excess malaria burden in the GGHD over the study period. Yet, the fact that the trend of malaria prevalence in GGHD exhibited increasing slope, the identification of malaria cases near GGHD and significantly high prevalence of P. falciparum near the GGHD imply the possible role of the dam in maintaining malaria hot spot. Weak/absence of linear correlation be-tween malaria episodes and climatic variables does not prove absence of the association between malaria and climate variables. The blood survey positivity rate was very low suggesting the need for additional study before concluding whether the community based model of IRS works effec-tively to control malaria. In GGHD site, irrespective of the low prevalence noticed, the transmis-sion of malaria might have been maintained associated with the Dam. Recommendations  Regarding the increment of P. falciparum with altitude and that of P. vivax with distance from reservoir of dams, further exploration is needed.  There is a need to consider additional factors such as normalized difference vegetation index and the physico-chemical nature of the breeding sites of mosquitoes.  Attention needs to be given to the poor, distant and inaccessible households in the efforts of malaria intervention programmes. Well-tailored information, education and communi-cation (IEC) is needed to address the problem of non-users of LLINs.  Applicability of the community-based model of IRS need to be further explored in different localities to fully replace the district based model of IRS in the future.  Patient records at health facilities should include family identity (ID) so that spatial anal-ysis of diseases can be carried out by linking cases history to the family. Key words: Climatic variables, Ethiopia, Gilgel Gibe, hydroelectric dam, malaria trend, spatiotemporal dynamics, bed nets
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    Anemia and its Determinant Factors among Pregnant Women in Ebantu District, East Wollega Zone, Ethiopia
    (Addis Abeba University, 2013-08) Mitiku, Wondimu; Shiferaw, Solomon (MD, MPH); Hagos, Seifu (Bsc, Msc, MPH)
    Background: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birth weight. Anemia during pregnancy is associated with negative maternal and neonatal outcomes. However, there is limited data regarding prevalence of anemia and its determinant factors during pregnancy in western Ethiopia. Objective: To determine the prevalence of anemia and its determinants among pregnant women in Ebantu District, East Wollega zone, Ethiopia Methods: A cross-sectional study was carried out among pregnant women. A total of 625 pregnant women were screened for hemoglobin level. The test was determined using hemocue screening technique. Weight and height was measured & other determinants of anemia during pregnancy were also assessed using a structured questionnaire. Results: The prevalence of anemia as defined by the World Health Organization as hemoglobin level <11.0 g/dl was 35.5% with 95%CI (32.0%, 39.2%). From this, 23.7% had mild anemia and 11.9% had moderate and none with severe anemia. Multivariate analysis showed that birth spaces less than or equal to two years AOR (95%CI):1.5(1.1, 2.9), a history of abortion AOR (95%CI): 2.4(1.6, 3.6), having two or more abortions AOR (95%CI) 2.6(1.3, 6.2), illiteracy with COR (95%CI):2.974(1.5, 5.6) and AOR: 5.92(1.8, 18.9) were significantly associated with anemia in pregnancy. Conclusions: A higher percentage of pregnant women have mild to moderate anemia. The major determinants of anemia in pregnancy are illiteracy, short birth spaces less than or equal to two , history of abortion and lack of Iron supplementation while pregnant.