Ethiopian Journal of Health Sciences <p><em>Ethiopian Journal of Health Sciences</em> is a general health science journal addressing clinical medicine, public health and biomedical sciences. In rare instances, it covers veterinary medicine.</p>Other websites related to this journal: <a title="" href="" rel="nofollow" target="_blank"></a> Jimma University en-US Ethiopian Journal of Health Sciences 1029-1857 Copyright belongs to the journal. Table of content <p>Table of content for May-2021 issue.&nbsp;</p> Yibeltal Siraneh Copyright (c) 2021-05-01 2021-05-01 31 3 Editorial message <p>editorial message from the E-I-C of the the journal.&nbsp;</p> Abraham Haileamlak Copyright (c) 2021-05-01 2021-05-01 31 3 Factors Affecting Contraceptive Use in Ethiopian: A Generalized Linear Mixed Effect Model <p>BACKGROUND: Ethiopia is the second most populous nations in Africa. Family planning is a viable solution to control such fast-growing population. This study aimed to assess the prevalence of contraceptive use and its predictors in Ethiopia.<br>METHODS: About 4,563 women were drawn randomly by Central Statistics Agency from its master sampling frame. The survey was conducted from January, 2014 to March, 2016 within six months’ interval for the study period. The study was conducted using secondary data collected by PMA2020/Ethiopia project. Negative Binomial regression model was employed for data analysis. The model was selected using information criterion.<br>RESULTS: Predictors like easy access of health service, residence area, level of health institutions, regions, availability of community health volunteers, experience sharing, support from husbands, level of education and employment status of women as well as residence area significantly affected the performance of contraceptive use in Ethiopia. From the interaction effects of health centers with region and health post with number of opening days per a week were significant predictors of the contraceptive use.<br>CONCLUSION: The performance of contraceptive use was different from one individual to another because of their experience sharing, support from their husbands, employment status and education level. A woman who got encouragement to use birth control from her husband had good performance to be effective for her contraceptive use. There should be an experience sharing/orientation, about use of birth control to protect women from unwanted pregnancy. Hence, rural women should get experience from urban women.</p> Mulusew Admassu Awoke Seyoum Tegegne Copyright (c) 2021-05-01 2021-05-01 31 3 Feto-Maternal Outcomes of Obstructed Labor and Associated Factors among Mothers Who Gave Birth in Public Hospitals of West Shoa Zone, Central Ethiopia: Cross-Sectional Study Alem Getachew1, Negash Wakgari2*, Tolosa Gishille3 <p>BACKGROUND: Obstructed labor the major cause of adverse feto-maternal outcomes. Hence, the study assessed adverse fetomaternal outcomes of obstructed labor and associated factors among women who gave birth in public Hospitals of West Shoa Zone.<br>METHODS: Cross-sectional study design was conducted among 277 respondents. The required data were extracted from the mothers’ chart by using a systematic random sampling method. Checklists were used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with feto-maternal outcomes. The odds ratio with 95%CI and p-value were used to identify the significant variables.<br>RESULTS: In this study, 145(52.3%) and 157(56.7%) of the respondents had adverse maternal and fetal outcomes respectively. Mothers who were referred from the health center (AOR: 3.96, 95%CI: 1.61-9.8) and who had a trial of labor at the health center and home had a more likelihood of adverse maternal outcomes than those who were referred and had trial of labor at hospital respectively. In addition, mothers who were not followed by partograph and in labor for &gt;24hrs had also a more likelihood of adverse maternal outcomes than their counterparts. Likewise, newborns whom their mothers were not followed by partograph and mothers in labor for &gt;24 hrs had also a more likelihood of adverse fetal outcomes than their counterparts. Hence, health professionals should give special attention to early diagnosis and referral of obstructed labor to higher facilities.</p> Alem Getachew Negash Wakgari Tolosa Gishille Copyright (c) 2021-05-01 2021-05-01 31 3 Risky Sexual Practice among Street Dwelling People in Southern Ethiopia: A mixed-Method Study <p>BACKGROUND፡ The number of street dwellers in major cities in Ethiopia is rapidly increasing. However, their sexual health needs are not that much studied. Hence, this study assessed risky sexual practice and associated factors among street dwelling people in southern Ethiopia.<br>METHODS: A cross-sectional study employing a mixed method was conducted. For the quantitative part, a snowball sampling technique was made to conduct face-to-face interviews among 842 respondents. In-depth interviews among street dwellers and key informant interviews among stakeholders were conducted to collect qualitative data. A pre-tested and structured interviewer-administered questionnaire was used to collect data. The collected data were entered using Epidata and exported to SPSS for analysis, and qualitative data analyzed by thematic analysis approach.<br>RESULTS: About one third, 266(31.6%), of the participants had risky sexual practices within the last year of the study period. Sexual violence such as gang rape and same-sex practice were reported qualitatively. Male respondents (AOR: 3.24, 95%CI:2.09-5.02) had a more likelihood of risky sexual practice than females. Living in Dilla (AOR: 9.62, 95%CI: 4.49-20.58) and Wolaita Soddo towns (AOR: 14.35, 95%CI: 6.29-32.69) had also a more likelihood of risky sexual practice than living in Hawassa. Moreover, the daily average income of 21-50 Birr (AOR: 0.52, 95%CI: 0.29-0.92) had a less likelihood of risky sexual practice compared to those with a daily average income of 5-20 Birr.<br>CONCLUSION: Risky sexual practice among street dwelling people is found high. The Federal Ministry of Health and other stakeholders should work to cut risky sexual practices among street dwelling people.</p> Negash Wakgari Terefe Woyo Emnet Kebede Hirut Gemeda Samson Gebremedhin Wakgari Binu Copyright (c) 2021-05-01 2021-05-01 31 3 Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia <p>BACKGROUND፡ Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia.<br>METHODS: A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization’s case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected.<br>RESULTS: Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%;164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria.<br>CONCLUSION: Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.</p> Melkamu Berhane Netsanet Workneh Gidi Beza Eshetu Mulatu Gashaw Getnet Tesfaw Andreas Wieser Guro K. Bårnes Guenter Froeschl Solomon Ali Esayas Kebede Gudina Copyright (c) 2021-05-01 2021-05-01 31 3 A High Distribution of Resistant Pathogens among Critically Ill Neonates from Secondary Referral Hospital of Indonesia <p>BACKGROUND፡ The spread of resistant pathogens among critically ill neonates has increased in recent years. Therefore, information about the antimicrobial profile and its susceptibility over time helps to select the most appropriate therapy. The study assesses the distribution of resistant pathogens and its<br>susceptibility among neonates’ patients.<br>METHODS: Eight hundred and eight suspected neonatal infected from January 2011 to December 2019 were recruited anonymously in our retrospective, observational analysis. The study was conducted in the secondary-care level NICU which located on the western border of Jakarta, Indonesia. The MDROs<br>definition was define by Centre for Disease Prevention and Control (CDC) criteria and standardized international terminology. Microbial identification and susceptibility testing were carried out following standard protocols.<br>RESULTS: Culture positivity was found in 132 (16.3%) with dominating MDR-Gram negative bacteria 47 (61.8%). The most common pathogens were extended-spectrum β-lactamase and multidrug-resistant Acinetobacter 18 (38.3%), respectively. There were coagulase negative staphylococci 29 (38.2%) among<br>MDROs. Most of the Gram negative bacteria were highly susceptible to the combination of cefoperazone/sulbactam (79.6%), amikacin (88.7%), and tigecycline (77.1%). Staphylococcus aureus had a good susceptibility to almost all classes’ antibiotics. Candida isolates showed 100.0% susceptibility to all antifungal classes.<br>CONCLUSIONS: Our study highlighted the microbial profile along with its susceptibility among neonatal patients that able to provide necessary information for antimicrobial guidelines and policies for effective infectious case management.</p> Cucunawangsih Cucunawangsih Paulus Mario Christopher Nicolaski Lumbuun Copyright (c) 2021-05-01 2021-05-01 31 3 Effect of Community-Based Functional Aerobic Training on Motor Performance and Quality of Life of Children with Spastic Cerebral Palsy <p>BACKGROUND: Efficacies of community-based exercise programmes have been well reported but there is scarce information on the expediency of community-based rehabilitation in a society where many of children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. The study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP).<br>METHODS: Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I – II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40-80% maximum heart rate. Gross motor function (GMF), walk distance and quality of life were assessed<br>pre and post CBFAE training.<br>RESULTS: Significant improvement observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking+running+jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in Pain and impact of disability (67.93%, P=.049) and Participation and physical health (60.00%,P=.042).<br>CONCLUSION: CBFAE training contributes majorly to improved standing, walking, jumping and running and selfesteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.</p> Evans Osei OWUSU ANSA Wisdom Kwadwo MPRAH Monday Omoniyi MOSES Isaac OWUSU Enoch ACHEAMPONG Copyright (c) 2021-05-01 2021-05-01 31 3 Emergency Medical Service Providers’ Perception of Health- Threatening Stressors in Emergency Missions: A qualitative Study <p>BACKGROUND: Unknown and unpredictable situations cause emergency medical service (EMS) providers to experience various stressful factors. These factors are affected by sociocultural conditions and expectations of the casualty and affect EMS providers' performance and health at the incident scene. The present study was conducted to explore EMS providers' perception of stressful and health-threatening factors in emergency missions.<br>METHOD: This qualitative conventional content analysis was conducted in 2020. The participants included 16 EMS providers working at the Emergency Medical Services Department in Hamadan Province, Iran. The participants were selected using purposive sampling and underwent semi-structured interviews until data saturation. Data were analyzed using the Graneheim and Lundman method.<br>RESULTS: Analysis of the interview data yielded six subcategories (i.e., incident scene hazards, violence-related injuries, physical injuries caused by patient care/handling, ambulance crash-related injuries, emotional impact of patients' suffering and ailments, and highly stressful missions), two main categories (i.e., physical injuries and psychological tensions), and a theme of occupational injuries.<br>CONCLUSIONS: According to the results, in addition to having concerns about caring for patients and saving the injured, EMS providers also worry about potential threats to their own health. The present study identified and described some major stressors in emergency missions. Thus, for a better and more effective efficiency, the present study results can be used to reduce or modify stressors in EMS providers.</p> Ali Afshari Seyed Reza Borzou Farshid Shamsaei Eesa Mohammadi Leili Tapak Copyright (c) 2021-05-01 2021-05-01 31 3 Abandonment at the Transition from Hospital to Home: Family Caregivers’ Experiences <p>BACKGROUND፡ People with concurrent chronic conditions face different situations that lead to frequent transferring between the hospital and home. Despite the use of different strategies for improving transitional care, these transferring is associated with different challenges. This article aims to explore family caregivers’ experiences of transitional care in diabetes with concurrent chronic conditions.<br>METHODS: This descriptive explorative study was done at university hospitals in two big cities (Isfahan and Tehran) of Iran. The data collection was conducted from November 2018 to February 2020 using deep, semi-structured, and face-to-face interviews which are focused on family caregivers’ experiences of transitional care. The researchers continued the sampling until the data saturation. Finally, 15 family caregivers were selected through purposive sampling. Data collection and data analysis were performed concurrently. Data were analyzed through the conventional content analysis method.<br>RESULTS: Two main themes were identified: unsafe transition (unplanned discharge, inappropriate communication, lack of patient center care, and unavailable healthcare team) and erosive effort (financial burden, psychological stress, physical exhaustion, and lack of supportive sources).<br>CONCLUSION: The findings point to the importance of designing a discharge plan and preparing family caregivers before being discharged by healthcare providers. It appears to be essential for health managers and policymakers to pay attention to safe transitional care planning. The establishment of<br>transitional care centers will help to ensure continuity of care. Future research focusing on the design and implementation of an appropriate transitional care model is recommended.</p> Alireza Nikbakht-Nasrabadi Leila Mardanian-Dehkordi Fariba Taleghani Copyright (c) 2021-05-01 2021-05-01 31 3 A Hospital Performance Assessment Model Using the IPOCC Approach <p>BACKGROUND፡ Developing a practical model to assess hospital performance improves the quality of services and leads to patient satisfaction. This study aims to develop and present such a model using the IPOCC (Input, Process, Output, Control and Context) approach.<br>METHODS: This study used a mixed-method research. The statistical population of the qualitative part included 27 experts who were purposefully selected and the sampling process was continued by the snowball method until the data saturation was reached. The quantitative part included 334 managers at different<br>levels within a hospital, who were selected by a random sampling method based on Cochran's formula.<br>RESULTS: The hospital evaluation model has 5 dimensions with 20 factors: input (human, financial, physical, information and equipment), process (treatment, para-clinical, prevention, management, and leadership processes), outcome (patient, staff and community outcomes and key performance index), control (internal control, external control), context (hospital culture,hospital status, the role of evaluators and community conditions). The value of chi-square was 4689.154, the degree of freedom was 2385, and the ratio of chi-square to the degree of freedom in the model was 1.966, which is an acceptable value. The values obtained from CFI, GFI, and IFI fit indices were acceptable. The SRMR index was 0.1130.<br>CONCLUSIONS: Using a performance assessment model along with the IPOCC approach evaluates hospital processes and the output obtained from the proper implementation of these processes in all areas. The areas include the hospital provided services like the control and context, or the traditional perspectives like physical, human, financial, and equipment resources.</p> Roya Malekzadeh Ghasem Abedi Edris Hasanpoor Matina Ghasemi Ghahraman Mahmoodi Copyright (c) 2021-05-01 2021-05-01 31 3 Prevalence and Associated Factors of Burnout syndrome among Nurses in Public Hospitals, Southwest Ethiopia <p>BACKGROUND: The Burnout syndrome has been defined as a response to the chronic work-related stress typically found in professionals working in care service organizations. Therefore, this study aimed at assessing the prevalence of burnout syndrome and factors associated with burnout syndrome among nurses in public hospitals, Southwest Ethiopia, 2018.<br>METHOD: An institutional-based cross-sectional study was conducted from February 1st, 2018 to April 1st, 2018. Total number of nurses who fulfill the inclusion criterias were enrolled. Data was collected using the predesigned tool. Data were entered using EPI INFO version 7 and was exported to statistical packages for social science (SPSS) version 21.0 for analysis. Logistic regression was employed and odds ratio with a 95% confidence interval was used. Variables with a P value of less than 0.05 was considered statistically significant.<br>RESULTS: A total of 282 eligible nurses were enrolled in the study with a mean age of 28.71 [SD ±7.047]. The prevalence of burnout syndrome among nurses was 96(34%). Predictor variables like; educational status, job title, work experience, fatigue, and social support were found to be strong predictor variables for burnout syndrome.<br>CONCLUSION: This study revealed that a considerable proportion of nurses had burnout syndrome. Therefore, improved educational status and strong social support should be encouraged among nurses working in the health setting for the betterment of health care services, job satisfaction and quality of care in general.</p> Alemayehu Sayih Belay Melak Menberu Guangul Wondwossen Niguse Asmare Sitotaw Kerie Bogale Gizachew Ayele Manaye Copyright (c) 2021-05-01 2021-05-01 31 3 Improving Hand Hygiene Compliance of Intensive Care Unit by Using Pender’s Model <p>BACKGROUND፡ Hand hygiene (HH) compliance is an effective behavior in controlling hospital-acquired infection because the hand is the main means of transmitting infections in patient-medical staff communication as well as the inanimate environment. This study aimed to explore the effect of applying Pender’s Health Promotion Model on the HH compliance of intensive care unit staff.<br>METHODS: This quasi-experimental study with a single research group was conducted from January to July in 2019. The required data were collected from 90 staff of the intensive care units of Imam Reza Hospital in Mashhad, Iran through 1796 and 2343 opportunity of monitoring before and after the intervention. The data collection instruments were a standard HH observation form and a researcher-made HH questionnaire in the light of Pender’s health promotion model. The data were statistically analyzed in SPSS using Paired-samples T-test and Chi-squared test.<br>RESULTS: The mean age of the 90 included participants was 35.92 (± 6.5) years and the mean length of their work experience was 10 (±1.5). The hand hygiene index rose from 23% before the intervention to 41.4% after the intervention (p=0.001). Moreover, statistically significant differences were found in moments after touching surroundings (p=0.001), before and after touching a patient (p=0.001), and also in perceived barriers (p=0.015), interpersonal influences (p=0.008) and situational influences (p&lt;0.001).<br>CONCLUSION: Pender’s model showed to have improved the staff’s HH compliance as a professional behavior.</p> Nasrin KHosravi Ali Alami Mohammad Hasan Aelami Shahla KHosrovan Copyright (c) 2021-05-01 2021-05-01 31 3 Gender and Age Differences in Cardiac Size Parameters of Ghanaian Adults: Can One Parameter Fit All? Part Two <p>BACKGROUND፡ The cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana.<br>METHOD: Plain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years’ experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR (TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses.<br>RESULTS: A total of 2004 patients’ chest x-rays were used in the analyses. The ages of the patients ranged from 20-86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statistically<br>significant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30-39 (p=0.046), 40-49 (p=0.001), 50-59 (p=0.001) and 60-69 (p=0.001).<br>CONCLUSION: The study reveals there are significant gender and age-related differences in cardiac size parameters obtained<br>from routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups.</p> Edmund Kwakye Brakohiapa Benard Ohene Botwe Benjamin Dabo Sarkodie Copyright (c) 2021-05-01 2021-05-01 31 3 Prevalence of Low Self-esteem and Mental Distress among Undergraduate Medical Students in Jimma University: A Cross- Sectional Study <p>BACKGROUND፡ Medical students often experience chronic stress. Self-esteem is one of the most important factors in the process of psychosocial growth and has remarkable effect on thoughts, feelings, values, and goals. The aim of this study was to assess the prevalence and associated factors of low self-esteem (LSE) and mental distress among Medical Students of Jimma University.<br>METHOD: This cross-sectional study was conducted in Jimma University from June to July, 2018. Self-esteem was measured with Rosenberg self-esteem scale. Self-administered Short form with General Health Questionnaire was used to assess presence of mental distress.<br>RESULT: Out of 422 students enrolled to the study, 279 (66.1%) were male, and 413 (97.9 %) were 18 to 25 years of age. The prevalence of LSE and mental distress were 19.0%, and 19.7 %, respectively. Students who had LSE had 5 times higher risk of having mental distress, AOR= 5.1 (95% CI, 2.9-8.9). Moreover, female students had higher risk of developing mental distress (AOR=1.9, 95% CI, 1.1-3.3). Students who had poor social support were 4.3 times at higher risk of developing LSE, AOR=4.3 (95% CI, 1.9-9.8). Those who reported to have poor academic performance were also more likely to have LSE AOR= 3.7 (95% CI, 1.3- 10.0).<br>CONCLUSION: One in five medical students had LSE and it is strongly associated with metal distress. Female students were at higher risk of mental distress. Preventive, curative and rehabilitative mental health services should be available for medical students with particular attention to those with poor<br>social support.</p> Netsanet Workneh Gidi Ararsa Horesa Habtemu Jarso Workineh Tesfaye Gudina Terefe Tucho Mubarek Abera Siraneh Jemal Abafita Copyright (c) 2021-05-01 2021-05-01 31 3 Illness and Treatment Perceptions of Patients with Epilepsy Attending Treatment at a Tertiary Hospital in Addis Ababa – A Qualitative Exploration <p>BACKGROUND: Epilepsy can be a large economic burden in countries where appropriate treatment is not taken due to religious and psychosocial beliefs. The objective of this study was to explore the perceptions and experiences of patients with epilepsy attending their treatment at Tikur Anbessa Specialized<br>Hospital about their illness and treatment.<br>METHODS: A qualitative exploratory design with an in-depth interview was followed. Fourteen purposively selected patients were used until saturation of key emerging themes was achieved.<br>RESULTS: The finding showed that study participants expressed perceptions towards their illness including about its cause, timeline, severity and psychosocial consequences which at times may be considered different from the biomedical version. They also expressed concerns about their treatment, reported about<br>social and psychological issues and in certain cases dissatisfaction with their healthcare providers. Such issues may have led to delays in treatment-seeking and non-adherence to recommended treatment regimens and as well use of traditional medicine and spiritual healing. On the other hand, reasons that were reported to positively influence their treatment experiences include necessity perceptions about their medications, family support and use of spiritual healing alongside their biomedical treatment.<br>CONCLUSION: The healthcare provision should improve to cater to these groups of patients including instituting chronic care management and appropriate health education provision.</p> Bezawit N. Demissie Abenet T. Mengesha Bruck M. Habte Copyright (c) 2021-05-01 2021-05-01 31 3 Exploring the Process of Spiritual Health of the Elderly Living in Nursing Homes: A Grounded Theory Study <p>BACKGROUND፡ Spiritual health is one of the important dimensions of the elderly’s health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes.<br>METHODS: This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling and<br>then, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008).<br>RESULTS: Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes.<br>CONCLUSION: Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health.</p> Ali Jadidi Masoud Khodaveisi Efat Sadeghian Masoud Fallahi- Khoshknab Copyright (c) 2021-05-01 2021-05-01 31 3 Major Dietary Patterns Relationship with Severity of Coronary Artery Disease in Gaza-Strip, Palestine: A Cross-Sectional Study <p>BACKGROUND፡ The association of dietary patterns (DPs) linked to the severity of coronary artery disease (CAD) is little known. Therefore, this study aims to explore the relationship between major DPs and the severity of CAD.<br>METHODS: This cross-sectional study was conducted among423 newly discovered CAD patients (both genders, aged 35-65 years), who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested using a semi-quantitative food frequency questionnaire and other related data through face-to-face interviews. Factor analysis and logistic regression were applied by using SPSS version-24.<br>RESULTS: By principal component analysis, two major DPs were identified: “Unhealthy” DP that characterized mainly by high intakes of sugar and sweets, soft drinks, salts, cooking oils, and processed meats, and “Healthy” DP that consisting high intakes of fruits, fish, poultry, vegetables, whole grains. After adjustment for confounding variables, the odds of severe CAD was significantly higher in the third (T3) and second (T2) tertile of the unhealthy pattern by 4.79 and 2.48 times more compared to the first tertile (T1) (OR 4.79; 95%CI 2.60, 8.83; P&lt;0.001) and (OR 2.48; 95%CI 1.40, 4.39; P=0.002), respectively. However, the odds of CAD severity in the T3 and T2 of the healthy pattern was lowered by 0.24 and 0.38 times less compared to the T1 (OR 0.24; 95%CI 0.12, 0.47; P=0.002) and (OR 0.38; 95%CI 0.20, 0.73;P=0.006), respectively.<br>CONCLUSION: The severity of CAD was significantly increased by the unhealthy dietary pattern, while decreased by adherence to the healthy pattern.</p> Mohamed Kuhail Sakineh Shab-Bidar Mehdi Yaseri Kurosh Djafarian Copyright (c) 2021-05-01 2021-05-01 31 3 Serum Vitamin D Level among Multiple Sclerosis Patients in the Tropics: Experience from a Private Clinic in Addis Ababa, Ethiopia <p>BACKGROUND፡ Multiple sclerosis (MS) is an immune mediated disabling neurological disorder. Very little is known about MS in Ethiopia. The objective of this study was to determine the prevalence of hypovitaminosis D and associated factors in cohort of MS patients in Ethiopia.<br>METHOD: A cross-sectional observational study was conducted among 25 multiple sclerosis patients at Yehuleshet Specialty Clinic, Addis Ababa, Ethiopia.<br>RESULTS: The prevalence of vitamin D deficiency was 96% (n=24). The average serum vitamin D was 14.8 (±10.4) ng/mL. The mean age was 35.8 (±10) years. Females accounted for 80% (n=20). Relapsing and remitting MS was the commonest variant. Motor, sensory, and mixed symptoms accounted for 40% (n=10), 20% (n=5), and 24% (n=6), respectively. Cold or hot weather and stress were reported as worsening factors in 24% (n=6). Relapse rate was 44% (n=11). Fatigue and seizure disorder were reported by 80% (n=20) and 16% (n=4) respectively. Steroid is the commonest prescribed medication for the patients. A negative<br>correlation was found between serum vitamin D and age (r = -0.062, p = 0.7). Similarly, a negative association was observed between vitamin D and duration of illness (r = -0.311, p = 0.1). Fatigue was reported by those with moderate hypovitaminosis compared to those having severe hypovitaminosis (p=0.002). Seizure was reported more by those with vitamin D below 10ng/mL compared to those having above 10 ng/mL (p=0.004).<br>CONCLUSION: Our study demonstrates a high prevalence of hypovitaminosis D in Ethiopian MS patients. Hypovitaminosis D was associated with increment in age and duration of illness.</p> Biniyam A. Ayele Mehila Z. Wuhib Betesaida G. Zenebe Guta Z. Metaferia Copyright (c) 2021-05-01 2021-05-01 31 3 Evaluation of the Relationship Between Primary Spontaneous Pneumothorax and Exercise and Return to Previous Activities in Patients Referring to Hospitals of Rasht during 2015-2017 <p>BACKGROUND: The most common cause of primary spontaneous pneumothorax (PSP) is subpleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise the time. In this study, we tend to investigate the relationship between training and PSP and time of return to exercise and previous activities.<br>METHOD: This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2017 based on inclusion criteria. Variables were analyzed using Fisher's exact test, Chi-square, Mann Whitney U and t-test (p&lt;0.05).<br>RESULTS: The most common treatment type in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after four weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had a recurrence; of non-athletes, 9.8% had a recurrence. Of athletes, 4.8% did not tolerate returning to their last activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant.<br>CONCLUSION: Our study showed no significant difference between clinical manifestations and image findings and the frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity.</p> Manouchehr Aghajanzadeh Mohammad Taghi Ashoobi Seyyed Mostafa Zia Ziabari Mohammad Reza Asgary Ramin Ebrahimiyan Ali Alavi Fomani Alirza Jafarnejad Azita Tangestaninejad Copyright (c) 2021-05-01 2021-05-01 31 3 Prevalence and Associated Factors of Suicidal Ideation and Attempt among Prisoners in Ethiopia: A cross-sectional study <p>BACKGROUND፡ Suicide is a serious cause of mortality worldwide and the single most common cause of death in the prison population. Studies on suicidal ideation and attempt among prison people in Ethiopia are limited. Therefore, the objective of this study was to assess the prevalence and associated factors of suicidal ideation and attempt among prisoners in Debre Markos Correctional Center, northwest, Ethiopia, 2019.<br>METHOD: An institution-based cross-sectional study was conducted using the simple random sampling technique; a total of 640 participants was recruited. Suicidal ideation and attempts were assessed using the suicidality module of the World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).<br>RESULTS: The prevalence of suicidal ideation and attempt were 21.9% and 13.1% with 95% CI (18.40, 25.20) and (10.60, 15.80) respectively. The study revealed that female sex (AOR=2.60, 95%CI: 1.39, 8.20) and family history of mental illness (AOR=2.08, 95%CI: 1.11, 3.90) were significantly associated with both suicidal ideation and attempt. Whereas divorced/widowed (AOR=3.67, 95%CI: 2.05, 6.58), common mental disorder (AOR=1.98, 95%CI: 1.25, 3.16) and poor social support<br>(AOR=2.68, 95%CI: 1.42, 5.06) were statistically associated with suicidal ideation, and previous incarceration (AOR=2.38, 95%CI: 1.20, 5.16) was significantly associated with a suicide attempt.<br>CONCLUSION: The result shows that the prevalence of suicidal ideation and attempt were serious problems among prisoners. As a result, inmate people need greater attention and interventions for suicidal behaviors.</p> Temesgen Tadesse Endashaw Habtamu Zehara Reshid Endalamaw Salelew Copyright (c) 2021-05-01 2021-05-01 31 3 Antimicrobial Resistance Profile of Bacterial Isolates Identified from Surgical Site Infections at a Referral Hospital, Northwest Ethiopia <p>BACKGROUND: Surgical wound infections (SWI) remain as a major source of postoperative illness that increases the time of hospital stay and health care related costs globally. On top of this, the emergence and spread of drug-resistant pathogens continue to challenge the proper management of surgical wound infections.<br>METHODS: A hospital based cross-sectional study was conducted at Felege Hiwot Referral Hospital (FHRH). A total of 165 study participants were included. Socio-demographic data were collected using a pre-tested structured questionnaire. Isolates were identified by conventional bacteriological technique and antimicrobial susceptibility test was performed using the Kirby-Bauer disc diffusion method.<br>RESULTS: Among 165 study participants, 98 (59.4%) were males. The overall prevalence of culture confirmed surgical wound infection was 115 (69.7%). A total of 125 bacteria isolates were identified among which, Staphylococcus aureus was predominant followed by Pseudomonas aeruginosa and Klebsiella species with<br>a proportion of 31 (24.8%), 26 (20.8%) and 17 (13.6%), respectively. Majority (80.8%) of the isolates were found multidrug resistant (MDR). Dirty wound and duration of hospital stay were found significantly associated with culture confirmed surgical wound infections.<br>CONCLUSIONS: S. aureus, P. aeruginosa and Klebsiella species were the most common isolates identified from surgical wound sites. Most of these pathogens were found MDR. Therefore, regular surveillance on the types of bacterial isolates and their drug resistance pattern should be considered.</p> Samuel Abosse Chalachew Genet Awoke Derbie Copyright (c) 2021-05-01 2021-05-01 31 3 Antimicrobial resistance and ESBL profile of Uropathogens among pregnant women at Edna Adan Hospital, Hargeisa, Somaliland <p>BACKGROUND: The emergence and spread of antimicrobial resistance (AMR) among uropathogens is increasing, especially in resource limited settings due to a number of reasons. The production of Extended Spectrum β-Lactamase (ESBL) by some strains of E. coli and methicillin resistant Staphylococcus species, limits the choice of antimicrobials in the treatment of urinary tract infection (UTI) globally. However, little is known about the type of uropathogenes and their current AMR profile among pregnant women in Hargeisa, Somaliland.<br>METHODS: Clean-catch mid-stream urine samples were collected and processed for bacteriological culture and antimicrobial sensitivity testing (AST). Ceftazidime (30μg) and Cefotaxime (30μg) disks were used for ESBL screening as per CLSI guideline and each ESBL screening positive isolate were phenotypically confirmed by a combination disk test.<br>RESULTS: Among 376 study participants, 79 (21.0%) had significant bacteriuria (SBU). Majority at 58(73.4%) of the isolates were Gram-negative. The most predominant isolate was E.coli, 36(45.6%) followed by K. pneumonea 16(20.3%) and S. aureus at 9(11.4 %). The proportion of ESBL producing isolates was 25(32.9%). Gram-negatives showed high level resistance to ampicillin, amoxicillin, cefotaxime, and cephalexin at 87%, 85%, 57%, and 52%, respectively. Previous history of UTI, monthly income, educational status and having dysuria were significantly associated with SBU (p&lt;0.05).<br>CONCLUSION: Relatively high prevalence of uropathogens and an increased level of drug resistance were documented. Therefore, continued surveillance on the type of uropathogens and their AMR pattern is needed to ensure appropriate recommendations for the rational empirical treatment of UTI and for policy input.</p> Hussein Mohamoud Senait Tadesse Awoke Derbie Copyright (c) 2021-05-01 2021-05-01 31 3 Tuberculosis Lymphadenitis and Human Immunodeficiency Virus Co-infections among Lymphadenitis Patients in Northwest Ethiopia <p>BACKGROUND: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest<br>Ethiopia.<br>METHODS: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P&lt;0. 05.<br>RESULTS: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007).<br>CONCLUSION: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.</p> Yohannes Zenebe Yesuf Adem Begna Tulu Daniel Mekonnen Awoke Derbie Zewdie Mekonnen Fantahun Biadglegne Copyright (c) 2021-05-01 2021-05-01 31 3 Frequency of Beta-Lactamase Antibiotic Resistance Genes in Escherichia Coli and Klebsiella pneumoniae <p>BACKGROUND፡ This cross-sectional study was performed on isolates of Klebsiella pneumoniae, and E.coli from clinical specimens of patients admitted to Sayyad Shirazi Hospital by census sampling method in 2019. Antibiogram testing was performed using the disk diffusion method as defined by the Clinical and Laboratory Standards Organization for performing this test. Finally, the abundance of genes was evaluated by PCR using specific primers. Frequency, percentage, mean±SD were used to describe the data. Chi-square and Fisher’s exact tests were used to compare the presence and absence of the studied genes alone and in the presence of each other.<br>RESULT: This study was performed on 130 positive samples, isolated from 32 (24.6%) males and 98 (65.4%) females with a mean age of 43.78 ± 21.72. From the total number of 130 isolates, 84 (64.6%) consisted of E.coli, and 46 (35.4%) were Klebsiella. Most of the cultures were urine and vaginal (61.5%). The highest antibiotic resistance in isolates was cephalexin and cefazolin (67.9% in E.coli &amp; 63% in Klebsiella). Colistin was identified as the most effective antibiotic (100%) in both. AMPC extendedspectrum β-lactamase genes were present in 40 (30.8%) isolates. The highest frequency about the gene pattern of AMPC positive β-lactamase bacteria was correlated to DHA, FOX, and CIT genes, while none of the samples contained the MOX β-lactamase gene. E.coli and Klebsiella beta-lactamase-producing AMPC isolates were also significantly correlated with antibiotic resistance to the cephalosporin class (P &lt;0.05).<br>CONCLUSION: This study indicated a high percentage of resistance to third and fourth generation cephalosporins. Hence, careful antibiogram tests and prevention of antibiotic overuse in infections caused by AMPC-producing organisms and screening of clinical samples for the resistance mentioned above genes and providing effective strategies to help diagnose and apply appropriate treatments and change antibiotic usage strategies can partially prevent the transmission of this resistance.</p> Roghieh Golsha Maryam Montazeri Nazanin Razaghi Mina Einollah Zade Copyright (c) 2021-05-01 2021-05-01 31 3 Comparing the Protective Effects of Curcumin and Ursodeoxycholic Acid after Ethanol-Induced Hepatotoxicity in Rat Liver <p>BACKGROUND፡ Alcohol consumption can cause hepatitis and long-term cirrhosis of the liver. The aim of this study was to evaluate the protective effects of curcumin (CUR) and ursodeoxycholic acid (UDCA) alone and together in the prevention and treatment of liver damage caused by overuse of ethanol.<br>METHODS: Adult Wistar rats were divided into 8 groups of 5, including the control group and various combinations of ethanol, CUR and UDCA groups. Twenty-eight days after the oral treatment, serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gammaglutamyl<br>transferase (GGT) and Arginase I (ArgI) as well as serum levels of Albumin (Alb), total protein (TP) and Blood Urea Nitrogen (BUN) were measured, and liver tissue was evaluated histopathologically.<br>RESULTS: The solo administration of CUR, UDCA and CUR+UDCA had no effect on the blood parameters and liver tissue compared to the control group (p˃0.05). The solo administration of CUR and UDCA in ethanol-treated rats significantly reduced ALT, AST, ALP, GGT, ArgI and BUN levels (p˂0.05), while the solo administration increased Alb and TP levels compared to the ethanol group (p˂0.05). In these groups, a significant decrease in cell necrosis and local inflammation of hepatocytes was observed, and the liver damage was mild. However, co-administration of ethanol, CUR and UDCA made significantly greater decrease in ALT, AST, ALP, GGT, ArgI and BUN levels (p˃0.05), while the co-administration greatly increased Alb and TP levels compared to the ethanol group (p˂0.05). Histopathologically, a decrease in structural changes in liver tissue and inflammation was observed, resulting in the improvement of liver tissue.<br>CONCLUSION: The solo administration of CUR and UDCA could reduce ethanol-induced liver damage in rats and improve liver’s serum and blood parameters. However, the coadministration of CUR and UDCA has a greater efficacy.</p> Azam Letafat Farashbandi Mehrdad Shariati Mokhtar Mokhtari Copyright (c) 2021-05-01 2021-05-01 31 3 Assessing the Practice of Birth Defect Registration at Addis Ababa Health Facilities <p>BACKGROUND፡ Birth defects are conditions that exist at birth and cause structural changes in one or more parts of the body. In order to plan proper management and design preventive activities of these conditions, accurate tracking, registration and analyses of the registered data are important. We assessed the practice of birth defect registration at Addis Ababa health facilities.<br>METHODS: We retrospectively checked the existence of a separate birth defect registry book and assessed the delivery room registration book for completeness in registering birth defects. We also assessed the total number of birth defects registered during 2010-2015.<br>RESULTS: We assessed the practice of birth defect registration at 37 delivery service providing health facilities in Addis Ababa, 20 public and 17 private institutions. Of the 37 health institutions assessed, 23 registered birth defects (3 of them used a separate birth defect registry books, and 20 used a regular registration book to register birth defects). The remaining 14 did not register any congenital anomaly. Of the institutions that do not register congenital anomalies, 10 are private and four are public.<br>CONCLUSION: Only three delivery providing health facilities had a dedicated birth defect registry book which is close to ideal for a birth defect registration. There is a need for others to do the same until an electronic birth defect registration is established. This registration will serve as a resource for clinical governance and studies into quality of life, quality of care, etiology and prevention.</p> Mekonen Eshete Fikre Abate Berhane Abera Abiye Hailu Yohannes Demissie Peter Mossey Azeez Butali Copyright (c) 2021-05-01 2021-05-01 31 3