Epidemiology
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Item Assessment of Chronic Respiratory Symptoms, Reduced Lung Function and Associated Factors Among Traffic Police Personnel of Addis Ababa, Ethiopia(Addis Ababa University, 2025-06) Tesfaye,Eyerusalem; Ayele Belachew; Girma Taye; Tamire,Mulugeta(PhD); Kumie,Abera(PhD)Background: Chronic respiratory disease is a global public health challenge, specifically among occupational groups exposed to environmental pollution. Traffic police, who are frequently exposed to high levels of ambient air pollution, face the risk of developing chronic respiratory diseases. Understanding the prevalence of respiratory symptoms, assessing the lung function of traffic police, and identifying predictor factors for respiratory symptoms among traffic police personnel is crucial for developing effective public health interventions. Objective: To assess the prevalence of chronic respiratory symptoms, lung function, and predictor factors among field and in-office traffic police personnel in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study has been employed. Targeting field and in-office traffic police personnel respectively, as exposed to Vehicular related air pollution and control group. A simple random sampling procedure was applied to enroll 374 traffic police personnel. Data were collected using the ATS/ERS questionnaire and spirometry following the American Thoracic Society guidelines to assess respiratory symptoms and lung function parameters, respectively. Chi-square test, ANOVA, Multivariable logistic, and linear regression were applied to compare prevalence, mean, and measure association. Result: A total of 374 traffic police personnel; 249 field traffic police and 125 in-office traffic police personnel were involved in the study. Respectively, field traffic police personnel were found to have a significantly higher prevalence of chronic respiratory symptoms than in-office traffic police personnel with 32.93% (27.36 - 39.03) and 18.4% (12.53 - 26.2) (p<0.003). Sex, work experience, and job status were significantly associated with developing chronic respiratory symptoms. While sex, age, being a field traffic police, years of employment, and previous occupational exposure to air pollutants demonstrate a negative relationship with lung function parameters (FEV1 and FVC) occupational safety and training on health topics showed a positive association with lung function parameters. Conclusion: field traffic police personnel have higher odds of developing chronic respiratory symptoms, with lower lung function compared to in-office traffic police personnel. Stricter air quality regulation, Occupational Safety, and Health-focused modifications in the traffic police work environment are recommended. Longitudinal studies should be conducted to investigate further the impact of air pollution on respiratory health among traffic police personnel.Item Assessment of the Availability and Distribution of Health Services for Managing Common Non-Communicable Diseases in Ethiopia(Addis Ababa University, 2025-06) Ashebir,Rekik; Yelma,Mengistu(PhD); Addissie,Adamu(PhD)Background: Non-communicable diseases (NCDs) are the leading cause of preventable deaths globally, accounting for 39% of deaths in Ethiopia, where the health system is still underprepared to address them. Thus there is a need to have more evidence on health service coverage for responding to growing challenges of managing NCDs. Objective: This study aims to assess the availability, distribution and readiness of health services for managing common NCDs in Ethiopia. Methods: A secondary analysis of the 2014 and 2021/22 Ethiopian Service Provision Assessment Survey were done to examine the availability and distribution of health services facilities and its change in over the two periods. Service readiness score and logistic regression was also evaluated to predict if there is association between structural factors and NCD service availability. Data was analyzed using STATA statistical software. The 95% CI and P values were considered to determine the significance level. Result: The general service availability for NCDs was 100%, 90%, 88%, 87.2%, 83.36%, 81.95%, 77%, 69.06%, and 54.22% in Harari, Addis Ababa, Somali, Benishangul, Amhara, Oromia, Afar, and Gambella regions, respectively, whereas it increased across all regions except in Benishangul-Gumuz (52.9%) and Harari (80%). The service availability for cardiovascular disease, chronic respiratory disease, diabetes mellitus and cancer were 90.6%, 94.2%, 69.6%, and 27.8% in 2014 while it were 94.5%, 93.7%, 69.6% and 32.8% in 2021/22. The mean service readiness significantly increased for cardiovascular diseases (23.9% to 41.3%), chronic respiratory diseases (32.6% to 44.0%), diabetes (20.1% to 38.3%), and cancer (29.4% to 41.3%) between 2014 and 2021/22. Hospitals, urban facilities, and government owned facilities are significantly more likely to provide NCD services. Conclusion and recommendation: Even though, high proportion of facilities provide NCDs service (over 90% for CVD, diabetes and respiratory diseases) the actual readiness measured by tracer items remains lower (about 41–44%). Access to cancer services continues to lag significantly at 32.8%. There are also disparities across regions. Efforts need to be made to strengthen the quality of service and for regions showing low coverage.Item Magnitude of Mastectomy, Post-Mastectomy Health-Related Quality of Life and Its Predictors Among Breast Cancer Patients in Addis Ababa, Ethiopia.(Addis Ababa University, 2025-08) Mesfin,Roda; Getachew,Sefonias(PhD); Wondimagegnew,Abigiya(PhD)Background: Breast cancer is the most common cancer among women and a leading cause of cancer deaths, especially in low- and middle-income countries where mastectomy is often the only treatment option. Survivors face physical and psychological challenges, making it essential to assess post-mastectomy quality of life to inform strategies and programs that reduce the challenges. Objective: To assess the magnitude of mastectomy, post-mastectomy health-related quality of life and its predictors among breast cancer patients in Addis Ababa, Ethiopia. Methods: The study was conducted in three public hospitals in Addis Ababa—Tikur Anbessa Specialized Hospital, St. Paul’s Hospital Millennium Medical College, and Yekatit 12 General Hospital Medical College—selected for their oncology services and high patient flow. An institution-based cross-sectional design was conducted with a sample size of 271, proportionally allocated to the hospitals and selected via simple random sampling. Data were collected through medical records and face-to-face interviews using structured tools (EORTC-QLQ- BR45 and C30) supported with an open data kit (ODK). The data are then exported and analyzed using SPSS 25, applying descriptive statistics to assess the magnitude of mastectomy and post-mastectomy health-related quality of life status and logistic regression to identify factors affecting post-mastectomy health-related quality of life. Results: A total of 271 patients with breast cancer who underwent surgery were included in this study. The mean age is 44.86 ±10.9. Most of the respondents underwent mastectomy (97%), and the rest had breast-conserving surgery. The average post-mastectomy health-related quality of life score of patients with breast cancer was 64.7 (SD =15.7). Arm symptoms (AOR 5.3, 95% CI 1.26-22.39), physical function (AOR 3.3, 95% CI 1.01-10.46), emotional function (AOR 3.4, 95% CI 1.46-7.94), and social function (AOR 6.2, 95% CI 2.68-14.16) were independent predictors of poor health-related quality of life in patients with breast cancer who underwent mastectomy. Conclusions: The magnitude of mastectomy is high, with poor post-mastectomy HRQOL among breast cancer patients in Ethiopia. Key predictors included arm symptoms, along with physical, emotional, and social functioning. These underscore the need for policymakers, healthcare providers, and patients to enhance post-surgery care and develop better strategies that improve health-related quality of life.Item Length of Intensive care unit stay and its associated factors following open cardiac surgery: A retrospective study at the Cardiac Center Ethiopia(Addis Ababa University, 2025-06) Habtamu,Bezawit; Ali,Ahmed(Prof.); Gashaw,Zeytu(Dr.)Background: Prolonged ICU stay after cardiac surgery can lead to higher mortality, increased complications and poorer long-term outcomes. They also strain hospital resources by limiting access to operating rooms—an especially serious issue in countries with limited cardiac surgical services. Identifying risk factors for prolonged stays can support early detection and management of complications. Such findings can also guide improvements in clinical care and aid in resource planning. Objective: The purpose of this study is to determine the proportion of patients with a prolonged ICU stay following cardiac surgery and what factors are associated with prolongation. Method: An institution based cross sectional study was carried out on a sample of 580 by using retrospective data. Medical records were selected by using stratified random sampling technique. Data were then collected by using a data abstraction form prepared from extensive literature review. After data were collected it was cleaned and recoded and analysis started from Descriptive statistics followed by bivariable and multivariable logistic regression analysis. P value was set at 0.05 for significance. Result: Prolonged ICU stay (4 days or more) occurred in 26.6% of patients following cardiac surgery. Five independent variables were found to be associated with prolonged ICU stay including; Preoperative atrial fibrillation (OR=2.41, 95%CI= 1.00-5.80, p=0.04), Duration of cardiopulmonary bypass (OR=1.10, 95%CI=1.00-1.02, p=0.006), Postoperative bleeding (OR=3.04, 95%CI=2.05-6.75, p=0.004), Postoperative AKI (OR= 17.02, 95% CI= 1.52 – 189.87, p=0.02) and other complications (OR=3.73, 95% CI= 1.42-6.48, p=0.0001). Conclusions: This study examined why some patients stay longer in the ICU after open cardiac surgery. It identified that 26.6% of patients had prolonged ICU stay. Several factors such as Preoperative Atrial fibrillation, Duration of cardiopulmonary bypass, postoperative AKI, Postoperative bleeding and other complications put patients at risk of prolonged stay. These finding can help clinicians identify and manage high-risk patients early and improve perioperative care which could help reduce duration of ICU stay.Item Incidence and Predictors of Inpatient Mortality among Road Traffic Accident Patients Admitted to Trauma Centers of Hospitals in Addis Ababa, Ethiopia (2020-2024): A Retrospective Cohort Study(Addis Ababa University, 2025-06) Bayisa,Deressa; Deressa,Wakgari(PhD); Taye,Girma(PhD)Introduction: Road traffic accidents (RTAs) result in the deaths, injuries, and disabilities of millions of people each year globally. Despite having fewer vehicles, low and middle-income countries (LMICs) account for a disproportionately higher share of road traffic fatalities and injuries. In Ethiopia, although the country experiences high mortality rates due to RTA, there is a lack of comprehensive data on the incidence and predictors of mortality among RTA patients admitted to hospitals. Objective: To determine the incidence and predictors of inpatient mortality among road traffic accident patients admitted to trauma centers of hospitals in Addis Ababa, Ethiopia. Methods: Institution-based retrospective cohort study was conducted among 482 RTA patients. A simple random sampling technique was used to select study participants. Data were collected using a pre-tested and structured data abstraction form through Open Data Kit (ODK). Descriptive statistics were used to summarize data. Kaplan-Meier survival analysis and the log-rank test were applied to assess the presence of differences in mortality incidence among different categories of predictor variables. Cox proportional hazards regression was employed to identify predictors. The model’s fitness was evaluated using the Cox-Snell residual. Variables with a p-value of < 0.25 in the bivariate analysis were included in multivariable analysis. Statistical significance was determined using a 95% confidence interval (CI) for the adjusted hazard ratio (AHR) and a p-value of < 0.05. Results: The cumulative incidence of mortality among RTA patients was 10.8% (95% CI: 12.00%, 18.03%), and the incidence density rate was 7.2/10,000 person-hours of observation. The mean survival time was 6.24 days. Factors significantly associated with mortality include Glasgow coma scale (GCS) < 8 (AHR 3.41; 95% CI: 1.09,10.71), developing complications (AHR 2.89; 95% CI: 1.22,6.85), systolic blood pressure (SBP) < 90mmHg (AHR 5.98; 95% CI: 2.30,15.51), a history of loss of consciousness (AHR 2.46; 95% CI: 1.12,5.40), and admission to the intensive care unit (ICU) (AHR 2.34; 95% CI: 1.18, 4.63). Conclusion: The Incidence of mortality among RTA patients was high. RTA patients with GCS < 8, developing complications, experiencing loss of consciousness, admission to the ICU, and SBP < 90 mmHg at admission were at high risk of mortality compared to their counterparts.Item Shared decision-making in cervical cancer care patients at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2025-06) Tilahun,Sosina Workineh; Addissie,Adamu(PhD, Associate Professor); Nega,Adiam(Bsc, MPH); Wagaw,Lealem(Bsc, Msc)Background: Shared decision-making is crucial for alignment of treatment options with patient values and preferences in clinical cancer care due to the complexity of treatment options and the significant impact of decisions on patients' lives. However, currently in Ethiopia, shared decisionmaking in clinical care of cancer, in which cervical cancer is not exceptional, is not well understood. Objectives: To determine the level of shared decision-making in the clinical care of women with cervical cancer and its associated factors. Methods: The study employed a convergent mixed study design from February to June 2025 at Tikur Anbessa Specialized Hospital. Quantitative data were collected through intervieweradministered questionnaires from 203 women undergoing treatment for cervical cancer. Additionally, qualitative data were gathered through in-depth interviews with 15 women with cervical cancer on follow-up, as well as 10 clinical oncologists who have provided care for these patients for the past three years. Statistical analysis was executed using software SPSS (version 26). Descriptive statistics were employed to summarize the variables of the study. Multiple linear regression analysis was then carried out to determine significant predictors of level of shared decision-making. Thematic analysis was conducted for the qualitative findings. Quantitative and qualitative findings were integrated to explain factors predicted the level of shared decisionmaking in the clinical care of women with cervical cancer. Result: With a ranging scale of 16–53 and a standardized mean score of 3.78 (± 0.54), the overall mean score for the current study's level of shared decision-making was 33.94 (± 9.11). According to this study, there are significant positive linear associations between higher levels of shared decision-making practice and younger age, separated marital status, active employment, increased trust in oncologists, short duration since diagnosis, and lower health literacy. The thematic analysis depicted socio-demographic, psychological, communication and institutional factors affecting practice of shared decision making in clinical care of women with cervical cancer. Conclusions: The study emphasizes the complex interplay of socio-demographic, psychological, communication, and institutional factors affecting practice of shared decision-making in the clinical care of women with cervical cancer. Thus, understanding these dynamics may help to enhance the practice of shared decision-making in the clinical care of women with cervical cancer.Item Acceptance of Electronic Medical Record System and Associated Factors among Health Professionals Working at Public Health Facilities in Addis Ababa, Ethiopia: a Mixed Methods Approach(Addis Ababa University, 2025-06) Adisu,Amanuel; Taye,Girma(PhD); Yilma,Mengistu(MPH, PhD Fellow)Background: Electronic Medical Records (EMRs) can potentially enhance the overall quality of healthcare services, including the availability and reliability of health information. Health professionals' computer literacy, willingness, knowledge, and attitudes toward Electronic Health Records significantly impact the acceptance and adoption of the EMR. Examining health professionals' acceptance and identifying barriers to EMR usage can provide valuable insights for recommendations to strengthen EMR implementation in healthcare settings. Objectives: To assess the acceptance level of EMRs and associated factors among Health Professionals working at public health facilities in Addis Ababa City Administration, Ethiopia, 2024/25 Methods: A cross-sectional study with both quantitative and qualitative approaches was carried out among 475 health professionals who worked at Addis Ababa's public health facilities during the study period. Face-to-face interviews using an electronic structured questionnaire were used to gather data, which was subsequently filtered for errors and missing values. The quantitative analysis was conducted using STATA version 17.0, and the qualitative analysis was conducted using Open Code version 4.03. Adjusted odds ratios with a 95% confidence interval were estimated using binary logistic regression and descriptive statistics. A p-value of less than 0.05 indicated that a variable was statistically significant. Result: Among 475 health professionals, 61.47% (95% CI: 57.08-65.87%) had good acceptance of Electronic Medical Records (EMRs). Key predictors included favorable attitude, good computer skills, adequate knowledge, and willingness to use. Challenges include lack of power and connectivity, system disruption, resource limitation, inadequate training and personnel resistance of the system. Conclusion: The findings revealed that 61.47% of respondents expressed a good level of EMR acceptance, driven by a favorable attitude, solid knowledge, strong computer skills, and a willingness to use the system. However, power outages, unstable internet connectivity, a lack of standard operating procedures, insufficient technical support, and the dual documentation burden (paper and electronic systems) hinder widespread adoption. Recommendations include infrastructure improvement, standardized guidelines, policy integration, training, and further research.Item Survival And Predictors Of Mortality Among Patients With Rheumatic Heart Disease Awaiting Valvular Surgery At Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Follow-Up Study, 2025.(Addis Ababa University, 2025-04) Akele,Bizunesh; Mekonnen,Hussien(Phd); Yadeta,Dejuma(MD, Cardiologist); Seid,Yimer(Phd Candidate)Background: Rheumatic Heart Disease is a condition in which the heart valves are damaged through repeated episodes of rheumatic fever. Globally, around 40.5 million people were affected by the disease, and >306,000 individuals died annually. In most cases, the life-saving treatment for Rheumatic Heart Disease patients is valvular surgery. However, such life-saving cardiac surgeries are limited in resource-limited settings like Ethiopia. Objective: This study aimed to assess survival and identify predictors of mortality among patients with Rheumatic Heart Disease awaiting valvular surgery at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A hospital-based retrospective follow-up study was conducted at Tikur Anbesa Specialized Hospital among 436 patients with rheumatic heart disease who were registered for valvular surgery from January 1, 2018, to December 30, 2023. Data were collected through the review of medical records and telephone interviews. The Kaplan-Meier method, life table, and log-rank test were used to estimate survival and comparison. Predictor factors were identified using an adjusted Cox regression model with their corresponding 95% confidence interval; p-value <0.05. Result: A total of 436 patients with Rheumatic Heart Disease were followed for 1,210.9 person-years, resulting in a mortality incidence rate of 108.89/1,000 person-years. The overall probability of survival at 2 years and 5 years was 80.9% and 59.0%, respectively. Independent predictors included right ventricular dysfunction (Adjusted hazard ratio: 3.03; 95% CI: 1.61–5.73), New York Heart Association class III/IV (Adjusted hazard ratio: 2.94; 95% CI: 1.58–5.46), multivalve lesion indicated for surgery (Adjusted Hazard Ratio: 1.54; CI: (1.05, 2.26), Infective Endocarditis (Adjusted hazard ratio: 2.39; 95% CI: 1.15–4.96), and patients aged <18 years had a significantly higher risk of mortality compared to those aged ≥18 with AHR=1.54, 95% CI, (1.01, 2.36). CONCLUSION: This study underscores the high mortality rate among rheumatic heart disease patients awaiting valvular surgery, emphasizing the need for urgent intervention, risk stratification, and strict patient follow-up.Item Factors Affecting Health Professionals' Adoption of Electronic Medical Records at Public Health Facilities in Harari Region in Ethiopia: a Mixed Approach(Addis Ababa University, 2025-07) Alemayehu,Ealroi; Getachew,Sefonias(PhD)Background :The Ethiopian Ministry of Health has realized the importance of electronic medical records (EMRs) and has been taking steps to introduce them across the country since 2013 to improve the quality of health care delivery in the country. In relation to this, Harari region state health facilities have managed to keep EMRs running, but no study has looked at the factors affecting the adoption of EMRs in the health facilities in the region using the comprehensive model in post-implementation phase. Since health professionals are users of the EMR, it is essential to comprehend factors affecting the adoption of the EMR. Objectives:To explore the factors that affect the adoption of Electronic Medical Records (EMRs) systems by the health professionals in Harari region public health facilities, in 2025. Methods:The cross-sectional study was employed to investigate the factors affecting the adoption of electronic medical records in public health facilities in the region. Health facilities that have implemented electronic medical records were included in the study. The data was collected using the selfadministered questionnaire and key informant interviews that involve the EMR users as study participants for the quantitative approach and HMIS head and IT personnel from each health facilities and regional health bureau for the qualitative approach. The data was analyzed using SPSS and ATLAS.ti for the quantitative and qualitative respectively. Results:A total of 351 respondents participated in the study making response rate of 95.9%. More than half of the respondents were female 204 (58.12%). The mean age (+SD) of the respondents is 32.34±8.9. The multivariate logistic regression revealed that being female (AOR=0.22, ( 95%,CI 0.054-0.90)). In contrast, higher personal innovativeness (AOR=20.783, [95% CI 2.54-170.49]), positive attitude (AOR=7.50,(95% CI 1.11-50.70), and higher experience (AOR=6.64, p<.005) are associated with increased intention to use. From the qualitative study factors like technology anxiety, experience, lack of necessary infrastructure, manpower, adequate training and electricity were identified. Conclusion:EMR users showed strong intention to use the EMR system, the barriers like technology anxiety, lack of infrastructure, resource, manpower, continuous training, electricity outage have been identified as a challenge that hinder the adoption. Providing technical and material support in addition to consistent follow-up is crucial to further improve the adoption.Item Risk factors for breast cancer among women attending the University Hospitals in South and Central Ethiopia, a case – control study.(Addis Ababa University, 2025-06) Gezahagn,Amanuel; Getachew,Sefonias(MPH, PhD); Kifle,Awigchew(MSc, PhD candidate); Munir(MD, Oncologist)Background: In Ethiopia, breast cancer incidence is rising and has become the foremost common cancer, causing high rates of morbidity and mortality. Because of the inconsistency in findings between studies conducted in Ethiopia, and no previous study has been conducted in the study area about the risk factors for breast cancer. This study aimed to identify the risk factors for breast cancer among women attending the University Hospitals in South and Central Ethiopia regions. Methods: An institutional-based matched case-control study was conducted among 378(189 women with BC and 189 women without BC) women attending selected university hospitals in the South and Central Ethiopia regions. Data was collected by interviewer-administered questionnaire and document review. Four University Hospitals were selected purposely based on the service they give specially chemotherapy service. Because of rare cases, cases were selected consecutively, while control was selected purposely from women visiting the selected hospitals for non-breast cancer cases based on the age of the case. A conditional logistic regression model was fitted to identify risk factors for breast cancer. The degrees of association between breast cancer and independent variables were assessed using an odds ratio (OR) at 95% CI. Result. A total of 378 women participated in this study for a response rate of 100%. The mean (SD) age of case and controls were 41.7(±11.13) and 41.5(±10.8) years. Above half of women 55.5% was diagnosed at late stage and 42% had breast cancer diagnosed with distant metastasis. According to conditional logistic regression model, unemployment (AOR 3.26(1.1-11.68), age at menarche (AOR 6.4(1.94-21.2)), parity (AOR 0.33(0.07-0.9)), intensity of physical activity (AOR 4.16(1.32-13.2)), consumption of solid oil (AOR 2.9(1.11-8.66)) and intake of packed food (AOR 3.48(1.12-10.9)) was significantly associated with breast cancer. Conclusions. This study found important risk factors for breast cancer. Therefore, there should be strong prevention work including awareness creation at the population level so that women will adopt healthier lifestyles through healthy nutrition and regular physical exercise, which might contribute to reducing the risk of developing BC. In addition, improving the early detection, and screening of breast cancer cases starting from the primary care settings for early identification and referral of breast cancer.Item Magnitude and factors associated with treatment interruption among HIV positive adolescents in selected public hospitals(Addis Ababa Universtity, 2025) Tessema Bayu; Wakgari Deressaw; Abigiya WondimagegnehuBackground: According to United Nations Programme on HIV/AIDS report an estimate of 1.6 million adolescents aged 10 to 19 were living with human immune virus worldwide in 2018. Even though antiretroviral therapy programs have expanded rapidly and are now freely available, treatment interruption remains major public health problem in the country. Objective: To assess the magnitude and factors associated with treatment interruption among adolescents living with human immune virus in four public hospitals of Addis Ababa, Ethiopia. Method: A cross-sectional study using retrospective record review of patient charts and computerized medical records was conducted for a period of September 2020 to December 2022. Data was collected from 297 samples which are proportionately allocated in those four hospitals based on patient flow. Extraction form was used to collect data and data collectors were assigned from among the medical staff employed by the antiretroviral therapy clinics of selected hospitals. After being examined, cleaned, and downloaded into an Excel file, the gathered data was exported to SPSS Version 26.0 for additional analysis. Descriptive statistics were employed and Bivariate and multivariate logistic regression model were used to identify associated factors for interruption of antiretroviral therapy. Results: In this study 17.5% of participants (95% CI: 9.56–33.38) interrupted their antiretroviral therapy one or more times from their appointments. Oral thrush (AOR=3.34, 95% CI: (1.47, 7.59), not taking Cotrimoxazole prophylaxis (AOR=3.42, 95% CI: (1.42, 8.24), one year on antiretroviral therapy (AOR=3.75, 95% CI: (1.47, 9.55)), not taking Dolutegravir related medication (AOR:3.85, 95% CI: (1.60, 9.27), and world health organization stages 1 and 2 (AOR=3.50, 95% CI: (1.25, 9.78) and (AOR=3.52, 95% CI: (1.02, 12.12) respectively were found to be significantly associated with this variables. Conclusion: nearly one in five adolescents living with human immune virus interrupted their antiretroviral therapy. To increase ART retention and meet the 2030 HIV/AIDS eradication strategy, we suggest several key recommendations for ministry of Health and other responsible program implementersItem Compiled Body of Works in Field Epidemiology(Addis Ababa Uinverstiy, 2025) Mesfin Tilaye; Alemayehu Worku; Sofonias Getachew; Getaneh Abrha; Habtamu TimerMeasles is a highly contagious viral disease and continues to be one of the leading causes of vaccine-preventable illness and death globally. In 2021 alone, an estimated nine million cases and 128,000 deaths were record, with sub-Saharan Africa bearing the greatest burden. The objective of the study was to investigate the measles outbreak in Lemi Kura sub-city of Addis Ababa. Methods: A descriptive cross-sectional epidemiological study was conduct in Lemi-Kura Sub-City, Addis Ababa, from 29 March to 7 May 2025. Data were obtain through structured face-to-face interviews, review of health facility records, and examination of line lists from the sub-city health office. After data cleaning, analysis was performed using Microsoft Excel 2016 and SPSS (version 26), and findings were described by person, place, and time; using tables and figures. Results: A total of 81 measles cases were report with no deaths. Females accounted for 50.6% of cases, and the median age was 5 years. Among the 81 reported measles cases, the majority 77.78% occurred in children aged 1–5 years, indicating that this age group was the most affected compared to those above 5 years 19.75% and under 1 year 2.47%.The overall attack rate was two per 10,000 population, with the highest in Summit 7/10,000 and Yeka Abado 6/10,000 health centers. Schools accounted for 45.7% of cases, mainly among children aged 3–5 years. Rash (100%), fever (96.3%), and conjunctivitis (63.4%) were the most common symptoms. The epidemic curve showed the first case on March 29, 2025, the number of cases increased across different health centers, reaching its peak on April 20, 2025. The epidemic began to decline after April 21, 2025, and subsequently. Conclusion and Recommendation: The measles outbreak in Lemi-Kura Sub-City underscores the need to strengthen routine immunization, improve vaccination monitoring, and address immunity gaps, particularly among children aged 1–5 years. Overcrowded living conditions and school-based transmission further emphasize the importance of targeted catch up vaccination, school-based checks, and intensified community outreach.Item Time to Initiation of Adjuvant Chemotherapy and its Predictors among Adult Colorectal Cancer Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia; a Retrospective Cohort Study 2013-2018.(Addis Ababa university, 2023-10-10) Sisay Lopiso ; Girma TayeBackground: Colorectal cancer (CRC) is world’s third most commonly diagnosed cancer type and the second most fatal cancer globally accounting for 10% and 9.4% respectively in 2020. Objectives: to assess the time to initiation of Adjuvant Chemotherapy (ACT) and its predictors among adults with CRC at Tikur Anbesa Specialized Hospital (TASH), Ethiopia, 2013 -2018. Methodology: The study was conducted at TASH, an adult oncology unit. An institution-based retrospective cohort study was done to assess the time to initiation of ACT and its predictors among adults with CRC. Data was collected by kobo toolbox and exported to STATA V17 software for analysis. Kaplan–Meier survival curve was employed to estimate the time to initiation of ACT and the overall survival of patients. The existence of significance differences was as checked by using the Log-rank test. Cox-proportional hazard model was used to identify significant factors associated with initiation of ACT and survival of CRC patients. Result: A total 135 patients were included in this study. Among this, more than half (60%) were males. The median age of the patient was 48. The median time to initiation of ACT among stage Ⅱ and Ⅲ CRC patients after surgery was 11 weeks. Underweighted were 56% less likely to initiate ACT compared to patients with those who had normal BMI Having comorbidities and surgical complications were other significant factors for initiation of ACT with hazard ratio of (AHR = 0.62, 95% CI: 0.22-0.64) and (AHR = 0.45, 95% CI: 0.26, 0.78) respectively. Significant association between initiation of ACT and overall survival was observed; those who initiated ACT late had almost three times higher risk of death compared to those who initiated early. In addition, patients with poorly differentiated cancer cells were four times at higher risk of death (AHR=4.05; 95% CI: 1.58, 10.37). Conclusion; This study revealed that time of initiation ACT was longer than the standard. Comorbidities, post-operative complication, and low BMI were identified factors for late initiation. The overall survival of patients at three- and five-years were low and significant association was found between late initiation of ACT and having poorly differentiated cancer cells. Therefore, actions should be taken targeting those factors delaying timely initiation of ACT and lowering the overall survival of CRC patients both at health facility and policy level.Item Compiled Body of Works in Field Epidemiology(Addis Ababa university, 2023-06-22) Alemayehu Abebe; Ahmed AliThe Ethiopia Field Epidemiology Training Program (EFETP) is a two year an in-service training program in field epidemiology adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) program. The program is designed to assist the Ministry of Health in building or strengthening health systems by recruiting promising health workers and building their competencies through on-the-job mentorship and training. The EFETP program has two main components, each of which contributes to the award of the Master‗s degree (MPH) in Field Epidemiology. A classroom-teaching component (25%) and practical attachment or field placement component (75%) consisting of disease investigations, surveillance evaluations, surveys, and applied research on national health problemsItem Compiled Body of Works in Field Epidemiology(Addis Ababa University, 2023-05) Ebsa File ; Negussie Deyasa; Wondimu AyeleThe Ethiopia Field Epidemiology and Training Programme (EFETP), which was inspired by the Centers for Disease Control and Prevention (CDC) in the United States, is a two-year in-service training program in field epidemiology. The program's goal is to recruit promising healthcare professionals and develop their competencies through on-the-job mentoring and training in order to help the Ministry of Health establish or strengthen health systems. The program is divided into two primary parts: classroom instruction (25%) and practical application or field placement (75%). The residency culminates in a final output of works that is equivalent to a thesis for the graduate school of public health in order to meet a portion of the requirements for a master's degree in field epidemiology. Eight chapters make up these outputs of work, which include a report on outbreak investigations, an analysis of surveillance data, an assessment of a surveillance system, a description of a health profile, scientific manuscripts for peer-reviewed journals, abstracts for scientific presentations, a proposal for an epidemiological research project, and yet another output report. Different approaches were used to complete these work products. In chapter one, two outbreaks were looked into: a malaria outbreak in the Loma district of the Dawro zone, in the SWEP region of Ethiopia, in June 2022; and a measles outbreak in the Raso district of the Afder zone, in the Somali region of Ethiopia, in May 2022. Chapters 2, 3, and 4 contain: Surveillance Data Analysis: National Malaria Surveillance Data Analysis, Ethiopia, 2016-2020 GC, Evaluation of the Malaria Surveillance System in Gambella Region, Gambella Zuria Woreda, Western Ethiopia and Health Profile Description of Bosat district, Oromia Regional State, Ethiopia 2021 included respectively. Chapters seven and eight of the document, Summary of Disaster Situation on Health and Nutrition Emergency Needs Assessment Report for the South West Ethiopia Region, Dawro Zone, June 2022, and Protocol/Proposal for Epidemiologic Research Project, which titled “Distribution of Malaria and Mosquito Species along Pagag Point of Entry in Lare Woreda, Gambella, Ethiopia: Cross Sectional Study. Finally, chapter nine includes one additional output of National Weekly epidemiological bulletin of Week 16: April 18 – April 24, 2022.Item Compiled Body of Work in Field Epidemiology(Addis Ababa University, 2023-09) Emiru Tessema ; Alemayehu Worku ; Abdulnasir AbagaroBackground: Ninety-Four per cent (94%) of malaria morbidity and mortality cases are attributed to the African region. Ethiopia is among ten African countries contributing to these cases. 60% of the Ethiopian population lives in malaria-risk areas with different levels of malaria risk. Although the country has made significant progress towards malaria elimination, seasonal outbreaks persistently resurface, including in previously non-malarious areas where people had low immunity. Abobo woreda is an epidemic-prone high-transmission area with stable transmission. However, the district experienced a malaria outbreak starting in the 21st Epi week of 2022, which prompted the investigation. Methods-We did a descriptive study, followed by two case-control studies with randomly chosen cases (86) and community controls (172).The malaria cases were confirmed with RDT or microscopy, and the controls had no symptoms during the outbreak. We collected data through a questionnaire given by an interviewer, entered it into Epi-info version-7, and analyzed it with SPSS version 20. We did bivariate and multivariable logistic regression to find out what factors caused malaria. Result: Between the 21st and 36th Epi weeks of 2022, 198 cases of malaria were reported, with no deaths. With a mean age of 22 (12.31 SD) years, the overall attack rate was 20.2/1000. The two most common species were Plasmodium vivax (PF) 71 (8%) and Plasmodium falciparum (PF) 755. Breeding location close to the house (AOR = 4.28; 95% CI: 1.8–10.27), sleeping outside (AOR = 3.94; 95% CI: 2.18–7.37), and a residence with open eaves (AOR = 3.82; 95% CI: 1.97–7.93) were all independent risk variables. Regular use of ITNS (AOR=0.195; 95%CI: 0.068–0.56), IRS-sprayed homes (AOR=0.42; 95%CI: 0.22-0.80), awareness of malaria transmission (AOR=0.51; 95%CI: 0.28–0.93), and preventative and control measures (AOR=0.50; 95%CI: 0.27–0.93) were protective measures. Conclusion and recommendation: Risk factors included sleeping outside, being close to a breading site, and having an open ceiling. However, taking preventative steps like utilizing ITNS, having your house sprayed with IRS, and being knowledgeable about prevention and transmission were all necessary. Regular environmental monitoring, a strengthened surveillance system, communication about behavioral change, ensuring sustainable use of profiled in chapter six's health section. Information on health and health-related topics that can be used for evidence-based planning and efficient use of scarce resources was offered. These data can be used to identify risk factors and prioritize public health problems for appropriate interventions. Chapter seven contains the Manuscript of the SAM Data analysis of the Somali region and the abstract of the health profile of Shebedino woreda, Sidama zone, Sept- 2021. Chapter Eight contains the epi-project proposal. The Epi-project proposal was developed to investigate the malaria outbreak and identify the risk factors that contributed to the outbreak in Abobo district, Agnuak zone, and Gambella. A descriptive epidemiology, supplemented by an unmatched case-control study, was conducted in Abobo woreda, from September 9–17, 2022. Chapter 9 includes six additional output types that were included in the CBOW: IDPs narrative presentation, Descriptive epidemiology of skin infection, COVID-19 backlogged data generation, Somali Region Afder Zone Drought Response narrative summary, and Dengue Fever response in Afar.Item Association Between Multi morbidity and Blood Glucose Control among Patients with Type 2 Diabetes Mellitus at Selected Health Centers, Addis Ababa, Ethiopia, 2024: Unmatched Case-Control Study(Addis Ababa University, 2024-06) Ephrata Tegen ; Ahmed Ali ; Yimer SeidBackground- Uncontrolled blood glucose level is an important public health concern due to the development of diabetic-related complications and death. Multi-morbidity is considerably more common in type 2 diabetes patients, and it can have a substantial effect on blood glucose control. However, despite a high prevalence of multimorbidity reported in Addis Ababa, its association with blood glucose control was not well studied in this study area. Objective- To assess the association between multi-morbidity and blood glucose control among adult type 2 diabetes patients at selected health centers, Addis Ababa, Ethiopia, 2024. Methods- A facility-based unmatched case-control study was carried out from February 12 to March 31, 2024, using interviewer-administered structured questionnaires and medical records. A multi-stage sampling method was employed in the selection of study participants. Data were collected using KoboToolbox and exported to the Statistical Package for Social Science version 26.0 for analysis. Bivariable and Multi-variable logistic regressions were utilized to determine the association between multi-morbidity and blood glucose control and other determinant factors associated with uncontrolled blood glucose. Results- The response rate of the study participants was 98%. From the participants, 148(43.3%)had multi-morbidity, of which 92 (80.7%) had uncontrolled blood glucose control. The presence of multi-morbidity (AOR: 6.52, CI: 2.92-14.54) was significantly associated with uncontrolled blood glucose levels. Moreover, medication non-adherence (AOR: 2.42, CI: 1.03-5.71), using oral hypoglycemic agent alone (AOR: 0.11, CI: 0.01-0.82), having polypharmacy (AOR: 0.03, CI: 0.01-0.16), dietary non-compliance (AOR: 4.44, CI: 1.8-10.94) and alcohol consumption(AOR: 3.63, CI: 1.36-9.69) were determinants of uncontrolled blood glucose level. Conclusion: This study showed that significant number of patients with type 2 diabetes mellitus failed to control their blood glucose levels due to additional non-communicable chronic diseases they had. Therefore, need to consider comprehensive patient-centered approaches that take into account the complex care needs of those patients living with multi-morbidity.Item Economic Burden of Diabetesmellitus on Patients and Their Families Attending Hospitals in Addis Ababa, Ethiopia(Addis Ababa University, 2023-12-13) Kebron Kilil ; Sale WorknehBackground: Diabetes is a chronic disease that imposes a substantial economic burden on countries, health systems, patients, and their families. The cost of treating and caring for diabetes puts a significant strain on household budgets exposing household for catastrophic expenditure. Objective: To determine the rate of catastrophic health expenditure, identify associated factors and coping strategies among diabetes patient attending in hospitals, Addis Ababa, Ethiopia. Method: A institutional-based cross-sectional survey was conducted in purposefully selected two public and two private hospital in Addis Ababa from July 3 to September 15 2023. A total of 391 adult diabetic patients who have had a hospital follow-up in the last 6 months or more were enrolled. A stratified sampling technique was applied. Patient data was collected through face-to-face interviews using a questionnaire administered via the ODK Collect app. Data was imported to STATA version 17 for analysis. Binary and multiple logistic regression was used to assess factor associated with catastrophic health expenditure, p value less than 0.05 was used as a significance level. Result: The study enrolled 387 diabetic participants with a response rate of 98%. The incidence of catastrophic health expenditure was 35.6% at 15% of non-food expenditure. Community-based health insurance membership (AOR = 0.222; 95% CI: 0.112–0.439),frequency of appointment (AOR = 0.262; 95% CI: 0.137–0.500) and emergency visit (AOR =10.863; 95% CI: 4.303–27.421) were statistically significant associated with catastrophic expenditure. Own money (saving and salary), family support and community based health insurance was the main coping mechanism to finance their treatments. Conclusion: The study revealed economic burden of diabetes is substantial and community based health insurance, frequent appointment and emergency visit were identified as factor associated with economic burden. Therefore, to alleviate the economic strain, community based health insurance should be expanded, frequent appointment and emergency visits should be decreased by following diabetes medication advice.Item Compiled Body of Works in Field Epidemiology(Addis Ababa University, 2024-10) Ashenafi G/Mariam; Girma Taye ; Adamu Adissie; Abdulnasir AbageroIntroduction: Any one of the four closely related viral serotypes can cause dengue. Mosquito Species is a vector for dengue for human transmission. The disease is most common in tropical and subtropical areas, where year-round transmission is made possible by mosquito vectors sustained by favorable environmental circumstances. The first-ever DF outbreak in the Somali region occurred in Godey Town, Ethiopia in 2014; a comparable outbreak was documente in DireDawa,Ethiopia, in 2013. The purpose of this study is to look into the outbreak, identify the etiology, and identify risk factors related to it. Methods: A total of 117 individuals were carefully chosen to participate in a community-based case-control study, consisting of 39 cases and 78 controls in a 1:2 ratio. The distribution of the disease by person, place, and time was assessed through a descriptive study based on the total number of cases during the outbreak. Following this, an unmatched case-control investigation was conducted to confirm the outbreak and identify its risk factors. Data were collected using structured questionnaires. Using Epi Info, the data was entered, and SPSS version 26 was used for analysis. To determine the relationship between the independent variable and the outcome variable, binary and multivariable logistic regression models were used. A p-value of 0.05 or less indicated that a variable was significant. Results: A total of 105 cases were found, and their attack rate and case fatality rate were 1.64 per 1000 and 0, respectively. 52 (49.5%) of these were female and 53 (50.5%) were male. Of 15 kebeles 14 kebeles from Gode town own are affected. The age group of 21 to 30 years old had the greatest age-specific attack rate and 15 kebeles 02 had the highest attack rate of 20.51/1000 population. An unmatched case-control study was conducted with 39 cases and 78 controls. having LLINs (AOR 0.038, 95% CI 0.003-0.543) and applying mosquito repellent on the skin (AOR 0.092, 95% CI 0.023-0.372) were found to be protective factors. On the other hand, not using LLINs (AOR 13.208, 95% CI 2.898-60.207) and the presence of larvae in the household (AOR 5.723, 95% CI 1.592-20.573) were identified as significant risk factors associated with dengue fever. Conclusion: having latrines and the use of mosquito repellent on your skin have a proactive factor so it needs to be aware the community and mosquito repellent supply should be encouraged. No usage of LLINs and the presence of Larvae in the household have a significant association with the disease pattern of the area so needs to conduct vector control activities at the household level and enhance risk communication and community engagement activitiesItem Time to Recovery and Predictors among COVID-19 Patients Under Home-Based Isolation and Care Services in Addis Ababa,Ethiopia.(Addis Ababa University, 2024-06) Ayele Bizuneh ; Zeytu Gashaw; Abigiya WondimagegnehuBackground: The COVID-19 pandemic has significantly impacted health systems globally.Ethiopia has recorded over 7,574 COVID-19-related deaths and nearly 500,000 confirmed cases. While 81.3% of cases in Ethiopia have been handled via home-based isolation and Care (HBIC),there are still uncertainties about the health consequences for patients receiving this type of care. Objectives: The objective of this study was to investigate the recovery experience of COVID-19 patients under home-based isolation and care services in Addis Ababa between January 17, 2023 and June 23, 2023. This includes time to recovery, recovery incidence rates, and associated factors. Methods: This retrospective cohort study was conducted in Addis Ababa from January 20,2024 to June 23, 2024. The study population comprised 272 COVID-19 patients who received HBIC from January 17 to June 23, 2023. Secondary data from the Ethiopian Public Health Institute and Armauer Hansen Research Institute was analyzed using Kaplan-Meier survival estimates and Cox regression model. Results: The analysis revealed an overall median recovery time of 7 days among COVID-19 patients within the HBIC. Specifically, vaccinated individuals had median recovery time of 7 days, while unvaccinated individuals had median recovery time of 8 days . The findings also indicated incidence density rates of 11.64, 13.19, and 10.34 recoveries per 100 person-days for the overall, vaccinated patients, and unvaccinated patients, respectively. Factors associated with time to recovery among COVID-19 patients under HBIC were: being vaccinated (AHR: 1.62, 95% CI: 1.18-2.23), Aged 30-39 (AHR: 2.13, 95% CI: 1.27-3.58), Absence of comorbidities (AHR: 1.87, 95% CI: 1.16-3.01), Prior infection (AHR: 2.11, 95% CI: 1.37-3.22), using public transport (AHR: 0.45, 95% CI: 0.32-0.65), smoking history (AHR: 0.44, 95% CI: 0.22-0.86), absence of mask use (AHR: 0.39, 95% CI: 0.28-0.55), lack of hand hygiene practice (AHR: 0.72, 95% CI: 0.53-0.99), and BMI ≤18.5 Kg/M2 (AHR: 0.67, 95% CI: 0.48-0.95) or 25-29.9 Kg/M2 (AHR: 0.38, 95% CI: 0.15-0.96). Conclusion: This study revealed the median time, rate and associated factors under home based isolation and care service. The relatively shorter median time among vaccinated groups indicate the viability of vaccination in recovery trajectories. The varying recovery rate with the different covariates and significant association of those covariates with time to recovery indicates the need for considering tailored interventions in those patients.