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> en-US Copyright belongs to the journal. (Abraham Haileamlak) (Journal Manager) Sat, 20 Feb 2021 09:10:11 +0000 OJS 60 Table of content <p>Table of content&nbsp;</p> Yibeltal Siraneh Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Editorial message <p>Editorial message&nbsp;</p> Abraham Haileamlak Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Preventive Practice and Associated Factors towards COVID-19 among College Students in Amhara Region, Ethiopia: A Cross- Sectional Study <p>BACKGROUND: Ethiopia has taken unprecedented preventive measures like closure of higher education institutions to halt the spread of COVID-19. However, still, there is scarce information regarding the knowledge, attitude, and practice (KAP) of students towards COVID-19 pandemic. Thus, this study aimed to assess the KAP and associated factors of preventive measures against COVID- 19 among students.<br>METHODS: A cross-sectional study was conducted on 422 students. The sample was proportionally allocated into the randomly selected four colleges, and the students were recruited using a systematic random sampling technique.Variables with pvalue &lt; 0.25 in the bivariate logistic regression analysis were entered into the multivariable logistic regression model.<br>RESULTS: This study involved 408 students with response rate of 96.6%. The levels of good knowledge, positive attitude and good practice towards COVID-19 were 69.6%, 56.6% and 65% respectively. After adjusting for covariates, being in the late adolescent age group (16-20), living with &gt; 5 family size, and being single were predictors of knowledge level. Besides, being single, attending diploma (TVET) level trainings, and being year-two students were predictors of attitude levels. Similarly, urban residence, being regular students, and being year-one students were the independent predictors of practice level of students.<br>CONCLUSION: In this study, only two-third of the students had good preventive practice level towards COVID-19, which is below the Organization’s recommendation. Thus, the national, regional and local governments should develop effective and inclusive prevention strategies to address students who are at home due to COVID-19 pandemic.</p> Abay Woday Tadesse, Negesse Melese Abebe, Sisay Eshete Tadesse3, Mulugeta Chanie Wube, Ahmed Ali Abate Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Mycobacterium Tuberculosis and Nontuberculous Mycobacteria Isolates from Presumptive Pulmonary Tuberculosis Patients Attending A Tertiary Hospital in Addis Ababa, Ethiopia <p>BACKGROUND፡ Mycobacterial infections are known to cause a public health problem globally. The burden of pulmonary disease from nontuberculous mycobacteria is reportedly on the rise in different parts of the world despite the fact that there is limited data about the disease in sub-Saharan Africa including Ethiopia. Hence, we aimed to assess the magnitude of M. tuberculosis and nontuberculous mycobacteria (NTM) among presumptive pulmonary tuberculosis patients attending St. Paul’s hospital Medical College, Addis Ababa, Ethiopia.<br>METHODS: A cross-sectional study was conducted from June to September 20/2016. Morning sputum specimens were collected, processed and cultured in Lowenstein Jensen medium and BACTEC MGIT 960 media. The nontuberculous mycobacteria were further confirmed and characterized by Genotype CM/AS assays. The socio-demographic, clinical and chest x-ray data were collected using a structured questionnaire. The data was analyzed using SPSS version 20.<br>RESULTS: Out of 275 presumptive tuberculosis patients enrolled in the study, 29(10.5%) were culture positive for Mycobacteria. Of these, 3(10.3%) were found to be NTM and 26(89.6%) were Mycobacterium tuberculosis complex. Of the NTM, two were unidentified and one typed as M.peregrinum. There was no coisolation of Mycobacterium tuberculosis complex and nontuberculous mycobacteria. Overall, 6(23.1%) Mycobacterium tuberculosis complex isolates were resistant to at least one antituberculosis drug. Of these, two were multidrug resistant<br>tuberculosis cases (7.7%) detected from previously treated patients.<br>CONCLUSION: Relatively low magnitude of Mycobacterium tuberculosis complex and nontuberculous mycobacteria isolates were seen in the study area. Therefore, further study using a large sample size is needed to be done to consider nontuberculous mycobacteria infection as a differential diagnosis in presumptive pulmonary tuberculosis patients.</p> Daniel Kahase, Kassu Desta, Zelalem Yaregal, Bazezew Yenew, Getu Driba, Hilina Molalign, Absra Solomon, Fitsum Bekele Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Factors Associated with Multi-Drug Resistant Tuberculosis among TB Patients in Selected Treatment Centers of Amhara Region: A Case-Control Study <p>BACKGROUND: Multi-drug Resistant Tuberculosis (MDR-TB) is found to be a major public health problem both in developed and developing countries. Ethiopia is one of the 30 high MDR-TB burden countries in the world. Although several studies were done to identify the determinants of MDR-TB, the reported findings are heterogeneous across the world.<br>METHODS: Unmatched case-control study was conducted at Debre Markose Referral Hospital, Debre Birhan Referral Hospital, and Boru Media District Hospital in Amhara Region, Northern Ethiopia, from March 01/2019- April 30/2019. Cases were all tuberculosis patients with culture or line probe assay confirmed mycobacterium tuberculosis resistant to at least both Isoniazid and Rifampicin and registered on second-line TB treatment. Controls were all patients with Bacteriological (molecular) proven drug-susceptible TB strains and whose recent smears result were turned to negative and registered as cured from January 01/2014 – December 31/2018. A pre-tested checklist was used to collect the data.<br>RESULT: Of the total reviewed documents (393), 98 cases and 295 controls were involved in this study. And, 54(55.1%) among cases and 162(54.9%) among controls were males. sixty nine(70.4%) among cases and 163(55.3) among controls were within the age group of 26-45 years. In the multivariable logistic regression analysis, age between 26-45years old (AOR=3.35; 95% CI: 1.15, 9.77), previous history of TB treatment (AOR= 14.2;95%CI: 7.8, 25.3) and being HIV positive (AOR=4.4; 95% CI:1.8, 10.4) were significantly associated with MDR-TB.<br>CONCLUSION: Age between 26-45 years old, previously treated cases and TB/HIV co-infection were identified as the determinants of MDR-TB. Special attention should be given to age between 26-45 years old, previous history of TB treatment and TB/HIV co-infection to prevent and control MDR-TB in the local context.</p> Getahun Yeshiwas Ambaye, Gebiyaw Wudie Tsegaye Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Maternal Death Review at a Tertiary Hospital in Ethiopia <p>BACKGROUND፡ There is conflicting data on the rate and trends of maternal mortality in Ethiopia. There is no previous study done on the magnitude and trends of maternal death at Saint Paul's Hospital, an institution providing the largest labor and delivery services in Ethiopia. The objective of this study is to determine the magnitude, causes and contributing factors for maternal deaths in the institution.<br>METHODS: We conducted a retrospective review of maternal deaths from January 2016 to December 2017. Data were analyzed using SPSS version 20.<br>RESULTS: The maternal mortality ratio of the institution was 228.3 per 100,000 live births. Direct maternal death accounted for 90% (n=36) of the deceased. The leading causes of the direct maternal deaths were hypertensive disorders of pregnancy (n=13,32.5%), postpartum hemorrhage (n=10, 25%), sepsis (n=4, 10%), pulmonary thromboembolism (n=3, 7.5%) and amniotic fluid embolism (n=3, 7.5%).<br>CONCLUSION: The maternal mortality ratio was lower than the ratios reported from other institutions in Ethiopia. Hypertensive disorders of pregnancy and malaria were the leading cause of direct and indirect causes of maternal deaths respectively. Embolism has become one of the top causes of maternal death in a rate like the developed nations. This might show the double burden of embolism and other causes of maternal mortality that developing countries might be facing.</p> Matiyas Asrat Shiferaw, Delayehu Bekele, Feiruz Surur, Bethel Dereje, Lemi Belay Tolu Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Preterm Neonatal Mortality and its predictors in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study <p>BACKGROUND፡ Preterm neonatal death is a global problem. In Ethiopia, it is still high, and the trend in reduction is slower as compared to child mortality. Preterm neonatal birth is the leading cause. The magnitude and associated factors are also not well documented. Therefore, this study aimed to estimate the incidence of mortality and its predictors among preterm neonates in Tikur Anbesa Specialized Hospital (TASH).<br>METHODS: An institution-based retrospective cohort study was conducted among 604 preterm neonates admitted to Tikur Anbesa Specialized Hospital. Data were collected by reviewing patient charts using systematic sampling with a checklist. The data entry was done using EpiData version 4.2, and analysis was done using Stata Version 14.1. Kaplan-Meier and log-rank tests were used to estimate the survival time and to compare it. Cox proportional hazard was also fitted to identify major predictors. Hazard Ratios (HRs) with 95% Confidence Intervals (CI) were used to assess the relationship between factors associated with the occurrence of death. Finally, statistical significance was declared at p-value &lt; 0.05.<br>RESULTS: In this study, a total of 604 patient charts were reviewed; of these, 571 met the inclusion criteria and were recruited to the study. A total of 170(29.7%) preterm neonates died during the follow-up period. The median follow-up time of preterm neonate under the cohort was 21 days (IQR: 4, 27). The incidence rate was 39.1 per 1000-person day. Rural residency (AHR: 1.45 (95% CI: 1.1,4.8)), Maternal diabetic Mellitus (AHR:2.29 (95%CI: 1.43,3.65), neonatal sepsis (AHR:1.62 (95% CI: 1.11,2.37), respiratory distress (AHR:1.54 (95% CI:1.03,2.31), extreme prematurity (AHR:2.87 (95% CI:1.61, 5.11), and low APGAR score (AHR:3.11 (95% CI:1.79, 5.05) was found to be predictors .<br>CONCLUSION: The rate of preterm neonatal mortality is still an important problem. Having maternal gestational Diabetic Mellitus, neonatal sepsis, respiratory distress, and low Apgar score were major predictors for preterm neonatal mortality. Therefore, efforts have to be made to reduce the incidence of death and for timely management of mothers with Diabetic Mellitus. Healthcare professionals should also work on early diagnosis and treatment of preterm neonate with sepsis, respiratory distress, and low Apgar score.</p> Yared Asmare Aynalem, Hussien Mekonen, Tadesse Yirga Akalu, Bereket Gebremichael, Wondimeneh Shibabaw Shiferaw Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Neonatal Hyperbilirubinemia treatment by Locally Made Low-Cost Phototherapy Units <p>BACKGROUND፡ Hyperbilirubinemia is a very common finding in neonates and may occasionally cause severe morbidity and even mortality. Severe hyperbilirubinemia is typically treated, either with phototherapy or exchange transfusions. This study assessed the effectiveness of a locally manufactured phototherapy device for reducing serum bilirubin in neonates with severe hyperbilirubinemia.<br>METHODS: Retrospective chart review was carried out to assess the outcome of 32 infants who were treated for neonatal hyperbilirubinemia at Jimma Medical Center (JMC) from May, 2017 to April, 2018. RESULTS: Out of 75 charts reviewed, only 32 had subsequent bilirubin level determination, 18(56.3%) of them were males. The age at which jaundice was noticed and confirmed with plasma bilirubin level was 4 + 2.7 days (mean+SD). Sepsis was thought to be the cause of hyperbilirubinemia in 13(40.5%) of the cases, while hemolysis from ABO incompatibility or RH incompatibility contributed in 5(15.6%) and 3(9.4) of the infants respectively. The mean (minimum, maximum) level of baseline TSB was 21.4(14, 55) mg/dL. Five infants (15.6%) had exchange transfusions because of extreme hyperbilirubinemia. The duration of phototherapy and decline in TSB were 5.34 +2.8 days and 2.2+1.5mg/dl/day (mean+SD) respectively. The levels of TSB before and at the end of phototherapy were significantly different (p&lt;0.001).<br>CONCLUSION: Acceptable reduction of TSB was achieved by using locally manufactured PT devices. Benefits included better accessibility and lower price and maintenance costs. High mean baseline TSB was observed, and duration of phototherapy is prolonged which could indicate late diagnosis compared to similar studies.</p> Netsanet Workneh Gidi, Matthias Siebeck Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Determinants of Incomplete Childhood Vaccination among Children Aged 12-23 Months in Gambela Region, Southwest Ethiopia: A Case Control Study <p>BACKGROUND፡ Childhood vaccination is considered as one of the most cost-effective public health interventions. With an increasing dropout rate from vaccination, the factors for incomplete vaccination are not well explored. The objective of this study was to identify determinants of incomplete childhood vaccination.<br>METHOD: Community based case-control study was conducted from March 1-30,2018. Cases were children who missed at least one dose of routine vaccine while controls were children who completed all recommended doses. Face-to-face interviews were used to collect data. Multivariable logistic regression was performed in order to identify determinants with 95% CI and a pvalue of &lt;0.05.<br>RESULT: A total of 93 cases and 185 controls were participated in the study. Not attending postnatal care [AOR=2.16, 95% CI: 1.08-4.28], household not visited by health workers [AOR=3.99,95% CI: 2.13-7.48], postponing vaccination schedules [AOR =6.15, 95% CI: 3.08 -12.27], caretakers who had misconception of vaccination [AOR = 2.90, 95% CI: 1.53-5.52], unsatisfied care takers [AOR=1.970, 95% CI:1.04-3.74] and poor knowledge about vaccines [AOR = 2.33, 95% CI: 1.19-4.59] were determinants of incomplete childhood vaccination.<br>CONCLUSION: Failure to attend postnatal care, postponing vaccination schedules, having misconception for vaccine contraindication, households not visited by health workers, caretakers who had poor knowledge about vaccines and unsatisfied caretakers were determinantsof incomplete childhood vaccination. Based on the finding, it is recommended that health education should be improved to decrease caretakers’ misconception, poor knowledge and postponement of the vaccine schedule. It is also recommended to increase health workers household visit.</p> Asnake Mebrat, Lamessa Dube, Ayantu Kebede, Zemedu Aweke Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases <p>BACKGROUND፡ Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers.<br>METHODS: This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated.<br>RESULTS: The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients’ factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence.<br>CONCLUSION: The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients’ factors and time constraints.</p> Ahmed Hassan Albelbeisi, Ali Albelbeisi, Abdel Hamid El Bilbeisi, Mahmoud Taleb, Amirhossein Takian, Ali Akbari-Sari Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Improving Self-Care Management in Patients with Breast Cancer through Health Literacy Promotion <p>BACKGROUND: Self-care is one of the most important principles of life and the successful treatment of patients diagnosed with cancer. Also, the first step and the most effective factor for self-care is health literacy. Thus, the aim of this study is to evaluate the relationship between level of health literacy and self-care ability in patients diagnosed with breast cancer.<br>METHOD: Using an analytical-descriptive approach, the present study was conducted using a random access method among 120 patients diagnosed with breast cancer referring to Imam Reza Hospital of Tabriz University of Medical Sciences, during 2019. The data was gathered using two standard self-care questionnaires in patients diagnosed with breast cancer (SCHFIV6.2) and Health Literacy for Iranian Adults (HELIA). Data analysis was conducted using SPSS v22, through Pearson correlation tests and linear regression analysis.<br>RESULTS: The results indicate a positive and significant relationship among dimensions of health literacy including access, reading, appraisal, decision, and understanding, and dimensions of self-care including self-care maintenance, self-care management, and self-care confidence. Other findings show that reading, access and decisions have a direct and significant effect on self-care ability (P-value ≤0.01).<br>CONCLUSION: With regard to the direct and significant relationship of health literacy and self-care dimensions in patients diagnosed with breast cancer, enhancing their health literacy can result in improved self-care among them. In addition, due to the increasingly high prevalence of this disease among women, improving their health literacy can be effective in the treatment of this disease or in enhancing their quality of life.</p> Isa Ahmadzadeh, Mohammadhiwa Abdekhoda, Mahmud Bejani Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 The Association between Changes in Coronary Artery Calcium Scores, Dietary Intake, Physical Activity, and Depression Symptoms among the Population of Gaza Strip, Palestine <p>BACKGROUND፡ This study aimed to identify the association between macronutrient intake, physical activity, and depressive symptoms and changes in coronary artery calcium score among the population of Gaza Strip.<br>METHOD: The study sample consisted of 269 individuals who underwent non-enhanced coronary computed tomography using 64-slice MDCT (Siemens, Germany) at Al-Shifa medical complex between September 2017 and January 2018. The study participants were divided into two groups; group one, consisting of coronary calcium calcification scoring (CAC) of greater than zero (CAC score &gt; 0), and group two, CAC less than or equal to zero (CAC score ≤ 0). Data about macronutrient intake, physical activity, and depressive symptoms were collected using a validated selfadministered questionnaire. Additionally, the participants’ anthropometric characteristics and blood biochemical markers were measured.<br>RESULTS: Out of 269 participants, 45-recorded CAC score &gt; 0; 72% of them were males with a mean age of 52.6 ± 5.4 years. Significant differences between the two groups in terms of total energy, lipid intake, and carbohydrate were found (P-value of 0.020, 0.012, and 0.034, respectively). No significant differences were recorded in protein intake, physical activity, and depression. Multivariate logistic regression analysis under adjustment for possible confounding factors revealed that macronutrient intake, physical activity, and depressive symptoms were not associated with the development of CAC in two models. CONCLUSION: Based on our findings, macronutrient intake, physical activity, and depressive symptoms are not associated with the development of CAC among the population of Gaza.</p> Abdelrazeq Beram, Kate Zinszer, Nouf bamuhair, Samer Abuzerr, Kamal Jabre, Huda Gharbia, Abdel Hamid el Bilbeisi, Awny Ubeid, Waliu Jawula Salisu Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Modeling Frequency of Injuries per Vehicle Crash in Gurage Zone, Southern Ethiopia <p>BACKGROUND፡ Traffic accident is the most serious problem in developing countries like Ethiopia, which is among the leading cause of death with the highest increasing rate from year to year in Ethiopia. This research aimed to identify the associated factors on the frequency of injuries per vehicle crash in Gurage zone.<br>METHODS: A retrospective study was conducted to identify the contributing factors of a number of injuries per accident. The data were collected from all traffic control and investigation office of 13 Woredas (Districts) for the past five consecutive years from 2013 to 2017. Negative Binomial Regression model was employed to identify the associated factors that affect the number of injuries per accident.<br>RESULTS: A total of 334 accidents recorded in the last five years from 2013 to 2017 in Gurage zone.Two hundred eight three (84.73%) of the accidents were caused 610 number of injuries. The significantly associated factors of frequency of injuries per road traffic accidents were Drivers’ Age (IR: 0.9813; CI: 0.9664 -0.9962), Drivers’ Sex: Female (IR : 1.6386; CI : 1.2176 - 2.0596), Drivers’ vehicles ownership: Hired (IR: 1.4216; CI: 1.1697 -1.6735) and non-drivers’ related variables, like weather condition: Rainy (IR: 1.6041; CI: 1.2552 - 1.9529), road shape: street-square (IR: 1.7421 ; CI: 1.1908 - 2.2934) and vehicle type: Isuzu (load)(IR: 1.6845; CI : 1.2592 - 2.1098) Minibus (IR: 2.7253; CI 2.3129 - 3.1377).<br>CONCLUSIONS: This study found that, Driver’s related factors: Driver’s Age, Sex, Drivers’ vehicle ownership, and non-drivers’ related variables: Weather condition, Road shape, and Vehicle type were identified as significantly associated factors on the frequency of injuries per vehicle crash in Gurage Zone.</p> Biru Mohammed Derese, Dumga Kassahun Trueha Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Early Outcome of Laparotomy Wounds in Pediatric Patients in TASH, Addis Ababa, Ethiopia: A Six-Months Prospective Study <p>BACKGROUND፡ Surgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.<br>METHODS: We performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher’s exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.<br>RESULTS: Of 114 patients, median age was 46 months [range: 1day-13years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, &gt;1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96,p=0.003). Age (p=0.004) and malnutrition (p&lt;0.001) were significantly associated with wound dehiscence.<br>CONCLUSION: SSI and wound dehiscence are common in this setting. Wound contamination, antibiotics administration &gt;1 hour before surgery and operative time &gt;2 hours are independent predictors of SSI.</p> Fisseha Temesgen, Abay Gosaye, Nichole Starr, Woubedil Kiflu, Hana Getachew, Belachew Dejene, Amezene Tadesse, Miliard Derbew, Tihitena Negussie Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Knowledge and Attitudes about Organ Donation among Patient Companion at a Tertiary Hopsital in Ethiopia <p>BACKGROUND: Worldwide, the supply of organs continues to be much less than the demand. Many studies identify poor knowledge and negative attitude about organ donation for this. The purpose of this study was to assess knowledge and attitude towards organ donation and associated factors among people who accompany patient during hospital visit at tertiary hospital in Ethiopia.<br>METHODS: A hospital-based cross-sectional study was conducted from March 1st to May 31, 2019, at a tertiary hospital and the only transplant center in Ethiopia. The patient companions were interviewed with structured questionnaires. Descriptive statistics were presented and factors associated with good knowledge and favorable attitude were assessed using Binary logistic regression.<br>RESULTS: A total of 414 patient companion participated in the study. The mean age of the respondents was 35+13years, and 252(60.9%) were males. Forty-four (10.6%) of the study participants had good knowledge about organ donation. Male gender was significantly associated with improved knowledge (AOR=2.127 95% CI: 1.036, 4.368). A favorable attitude towards donation was found in 219(52.9%) of the study participants. Participants who had completed secondary education were more likely to have unfavorable attitude towards organ donation (AOR=0.498, 95% CI: 0.290, 0.857).<br>CONCLUSION: Knowledge about organ donation was found to be poor, and attitudes towards organ donation were found to be unfavorable among patient companions at a major medical center in Ethiopia. Strategies focused on education of the general public and broad dissemination of information on the benefits of organ donation will be critical for improving the organ donor pool.</p> Mahteme Bekele, Wubshet Jote, Tigist Workneh, Berhanu Worku Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Knowledge Translation Improvement Strategies in Universities of Medical Sciences in Iran: A Qualitative Study <p>BACKGROUND፡ Recently, one of the challenges in the health system of the country is the need for research contributing to policy-making. Therefore, it is crucial to develop activities in the field of knowledge Translation (KT). This study aimed to propose KT improvement strategies in universities of medical sciences in Iran.<br>METHODS: In this qualitative study, 18 semi-structured interviews were conducted with key informants from the medical universities in Iran during January-July 2018. The transcribed documents were analyzed using the Gale framework analysis approach. Data organization was carried out using MAXQDA version 10 software.<br>RESULTS: According to framework analysis, six KT improvement strategies were identified including improving the abilities and skills of researchers, improving the processes and quality of knowledge production, revising policies and laws, mproving the prerequisites, culture-building, and promoting the, use of evidence.<br>CONCLUSION: Given the challenges and strategies outlined in this study, it seems that the mechanism of KT and its effects on improving health plans for policymakers and researchers has not been elucidated yet. Therefore, considerable changes in prerequisites, knowledge production processes, academic procedures, policies and laws are necessary for implementing KT in universities of medical sciences in Iran.&nbsp;</p> Sogand Tourani, Narges Rafiei, Shahnaz Rimaz, Seyed Kazem Malakouti, Alireza Heidari Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study <p>BACKGROUND፡ Nurses require a great deal of knowledge to provide a comprehensive and effective nursing care. A number of patterns have been put into place to help nurses acquire this knowledge. The aim of this study was to describe the core variable in the process of using patterns of knowing by nurses in clinical practice.<br>METHODS: The study was conducted in qualitative and grounded theory approach, between April 2018 and January 2020. Semi-structured interviews were used for data collection. All the interviews were transcribed verbatim. Nineteen clinical nurses were interviewed, and eight observation sessions were conducted in different hospital departments. Participants were first selected through purposeful and then theoretical sampling. Data were analyzed and interpreted using constant comparison analysis approach.<br>RESULTS: The findings of the study indicated that nurses apply the patterns of knowing in three ways in their clinical practice: "cohesion of patterns of knowing", "domination of some patterns of knowing" and "elimination of some patterns of knowing". The core variable of this process is cohesion of patterns of knowing in the domain of flexibility.<br>CONCLUSION: The findings of the present study indicate that application of patterns of knowing is practiced in a range of nurse flexibility in clinical settings.</p> Forough Rafii, Alireza Nikbakht Nasrabadi, Fereshteh Javaheri Tehrani Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Modeling Subjective Symptoms Related to Micro-Hydrargyrism in a Population of Moroccan Dentists <p>BACKGROUND፡ The ability of mercury to deposit throughout the body and alter a wide range of molecular and cellular pathways results in a polymorphic and complex clinical phenotype with over 250 possible symptoms. However, some of them are recurrently cited as evoking chronic mercury poisoning. In this light, dentists users of dental amalgams are chronically exposed to mercury so that in-depth epidemiological investigations and adapted statistical methods are required to highlight adverse effects of this exposure.<br>METHODS: In order to study the health impact of the occupational mercury exposure in a population of liberal dentists practicing in two Moroccan regions, a list of eighteen subjective symptoms commonly associated with micro-hydrargyrism was drawn up. Then, seven statisctical models adapted to count data were fitted. Finally, three methods were used to compare their relative performance in order to choose the most appropriate one.<br>RESULTS: The adopted logical path, from the response variable selection till models’ comparison, led us to lean towards quasi- Poisson regression as the best way to predict the number of symptoms declared by dentists according to mercury exposure.<br>CONCLUSIONS: Interpretation of the selected model allowed us to conclude that the reduction of dental amalgam use allows the reduction of subjective symptoms related to mercury exposure.</p> Nourdine Attiya, Ayoub Filali, Rkia Fattahi, Soumia Moujane, Hamid Mazouz, Mohamed-Yassine Amarouch, Younes Filali-Zegzouti Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Risky Sexual Behavior across Extremes of Wealth in sub-Saharan Africa: A Meta-Analysis of Demographic and Health Surveys <p>BACKGROUND: Risky sexual behavior increases the risk of contracting sexually transmitted disease including HIV and other reproductive health problems.There have been varying assumptions and different reported result explaining the relationship between risky sexual behavior and wealth. This review was intended to examine the disparity of risky sexual behavior among the two extremes of wealth in sub-Saharan<br>African countries.<br>METHOD: This study reviewed demographic and health survey reports of sub-Saharan African countries. We excluded older reports and reports published in languages other than English. Finally, reports from 16 countries were considered for review. Data were entered in excel and transported to stata for analysis. Metaprop and Metan command were used to compute proportions and odds ratio. Standard chi-square and I square tests were used to assess heterogeneity.<br>RESULT: Pooled prevalence of having multiple sexual partner ranges from 2 to 12%. Over 80% of the countries reported that more than half of the individuals did not use condom at their last risky sexual intercourse. Poorest females were 0.62 [OR: 0.62, 95% CI (0.50, 0.78)] times less likely to have multiple sexual partners than males. Both males and females from the poorest wealth quantile had higher odds of not using condom at their last risky sexual intercourse, 1.41 [OR: 1.41, 95% CI (1.29, 1.53)], 1.41 [OR: 1.46, 95% CI (1.23, 1.73)], respectively.<br>CONCLUSION: Multiple sexual partners is relatively low in the region. Condom non-use is high in both genders. Additionally, poorest males and females were at higher risk of not using a condom at last risky sexual intercourse.</p> Rahma Ali, Afework Tadele Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Policies and Practices Catalyzing the Use of Generic Medicines: A Systematic Search and Review <p>BACKGROUND: The use of generic medicines instead of branded, is one of the main policies to decrease the expenditures and provide access to affordable and essential medicines in low and middle-income countries. The present study aims to systematically create a comprehensive synthesis of demand-side policies, encouraging the use of generic medicines.<br>METHODS: The study systematically searched and reviewed the articles in Medline, Scopus, Web of Science, and Embase from 1.1.2000 to 12.5.2019. A total of 6435 records were identified during this period of time (Medline (n=315), Scopus (n=4323), Web of Science (n=71) and Embase (n=1726)). All stages are conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyzed (PRISMA).<br>RESULTS: The encouraging policies and practices were classified into four categories from 44 articles analyzed, including; Prescribing, Dispensing, Patients/consumers, and healthcare organizations. Subthemes were also explored in relation to each category as; education, financial incentives, generic substitution, advertising approaches, and enforcement.<br>CONCLUSION: Various policies should be taken into consideration to encourage successful generic medication prescribing, dispensing, and consumption in both supply and demand-side. Economic, political, socio-cultural, technological, legal, and structural factors could as such accelerate the policies’ effect. Studying the experience of successful countries can be helpful for policymakers.</p> Shahmoradi Mostafa, Mosadeghrad Ali Mohammad, Jaafaripooyan Ebrahim Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Challenges of Reproductive Health Management in the Camps of Internally Displaced Persons: A Systematic Review <p>BACKGROUND Internally Displaced Persons (IDPs) in the camps face many reproductive health challenges. They should meet their needs timely to save their lives. This paper outlines a systematic review to discuss the challenges of reproductive health management in the camps of internally displaced persons.<br>METHODS: For this research, electronic databases including PubMed, Science Direct, Scopus, Pro Quest, Google Scholar and Cochrane Library till January 1, 2020 were searched. A threestage screening process was used for the selection of literature due to PRISMA checklist. Finally, a thematic synthesis approach was applied to analyze the data.<br>RESULTS: In total, 133 articles were identified; 11 articles met the inclusion criteria for entering the process of final analysis. The findings were demonstrated in six main categories of availability and accessibility of reproductive health services, sexual and gender-based issues, human rights, social and cultural issues, coordination and collaboration, and mental health issues. The remarkable result of this study highlighted that the main challenges are lack of access to health services, violence against women and lack of household education.<br>CONCLUSION: Results of this systematic review present valuable advice for policy makers and managers to prepare and respond effectively and timely to reproductive health challenges of internally displaces persons. Disaster preparedness plans and contingency plans for maintaining and developing reproductive health in IDPs camps are recommended.</p> Farin Fatemi, Shandiz Moslehi Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Prevalence and Associated Factors of Precancerous Cervical Lesions among Women in Ethiopia: A Systematic Review and Meta-Analysis <p>BACKGROUND፡ Cervical cancer remains the most common cancer of women worldwide. Its burden is more serious in developing countries. It is also the second common cancer deaths of women in Ethiopia followed by breast cancer. The aim of this study was to determine the pooled prevalence and associated factors of precancerous cervical lesions among women in Ethiopia.<br>METHODS: We systematically searched published and unpublished articles reported from 2010 to 2019 using a comprehensive search of electronic databases including PubMed and Google scholar for grey literature from August 1 to September 1, 2019. The methodological qualities of included studies were evaluated using Joanna Briggs Institute meta-analysis of Statistics Assessment. The pooled prevalence estimate was calculated using MedCalc software-version 19.0.7, and the pooled odd ratios for predictors was calculated using RevMan software version 5.3.<br>RESULTS: The pooled prevalence of precancerous cervical lesions among women in Ethiopia was 13.4% (95% CI:10.63% 16.37%). Statistically significant heterogeneity between studies was detected (I2=83.1%, P &lt; 0.001). Among all measured associated factors: numbers of women life time sexual partners &gt; 1, OR=2.5 (95% CI:3.70,4.76), being HIV positive women, OR=2.4 (95% CI:1.33,4.61) and women having history of STI, OR=2.0 (95% CI:1.02,3.87) had statistically significant association with precancerous cervical lesions among women in Ethiopia<br>CONCLUSION: The pooled prevalence of precancerous cervical lesions among women in Ethiopia was high as compared to the 5- year worldwide cervical cancer prevalence. Women having more than one life time sexual partners, being HIV positive women and women having history of STI had a statistically significant association with precancerous cervical lesions.</p> Dereje Zena, Berhanu Elfu, Kebadnew Mulatu Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Growing Ignorance of COVID-19 Preventive Measures in Ethiopia: Experts’ Perspective on the Need of Effective Health Communication Strategies <p>Despite the recent surge of COVID-19 infections in Ethiopia, we are observing a profound ignorance of preventive measures by the general public and leaders at different levels. This is presenting considerable challenges in the effort to contain and control the pandemic. We believe that the current health communication approach implemented by the health authorities and media outlets<br>need to be redesigned to bring a sustainable COVID-19 preventive behavior. The purpose of this perspective paper, therefore, is to stimulate discussions on effective health communication strategy to help the public persistently practice COVID-19 preventive measures over the long term. We undertook a series of discussions amongst the authors in order to synthesize individual viewpoints into ‘experts’ perspective’ driven by our daily observations and our expertise in the health service research. In light of this, we suggested that an effective health communication strategy need to address context specific situations to avoid temptation to ignore the ramifications of this very serious pandemic. This strategy includes trying to make sense of daily reported COVID-19 cases, being highly selective regarding sources of information, and being sensitive and responsive to religious and cultural factors. The media, health professionals, and leaders need to teach us how to live with the pandemic informed by robust scientific sources.</p> Zewdneh Shewamene, Fisseha Shiferie, Engida Girma, Befikadu L. Wubishet, Mizan Kiros, Atakelti Abraha, Abduljelil Reshad, Getachew Tiruneh, Benyam Worku, Eskedar Lemlemu, Rahel Belete Balkew Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 An Unusual Case of Type 1 Narcolepsy in an Ethiopian Patient <p>BACKGROUND: Narcolepsy is a chronic disabling central neurological disorder of daytime hypersomnia. It is categorized into two subtypes-type 1 (N1) and type 2 (N2). Symptoms of N1 commonly include excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, hypnogogic/hypnopompic hallucinations, and disturbed nighttime sleep. Ethnic differences have been observed, but they have not been reported in an Ethiopian patient to date.<br>CASE DETAIL: We report a 39-year-old Ethiopian patient with type 1 narcolepsy whose diagnosis was delayed for three decades despite severe symptoms. Her quality of life was significantly impaired and included EDS, sleep fragmentation, and depression. The mean sleep latency (MSL) for five naps was 1.3 minutes. Sleep-onset rapid eye movement (REM) periods (SOREMPs) were present in all five nap periods. HLA-typing and a CSF hypocretin level testing were not performed. Modafinil 300mg was prescribed, which improved her quality of life.<br>CONCLUSION: In developing countries where diagnostic studies are not available, practitioners should pay special attention to a detailed history and look for classic symptoms of narcolepsy to establish an early diagnosis and improve quality of life.</p> Asefa Mekonnen, Gregory Stimac Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000 Gilbert Syndrome in a Young Ethiopian Man: First Case Report <p>BACKGROUND፡ Gilbert syndrome is a well-recognized condition causing unconjugated hyperbilirubinemia with otherwise normal transaminases and liver function tests.</p> <p>CASE: A 21 year old male patient presented with recurrent episodes of jaundice over four years. The episodes were preceded by stressful conditions and intercurrent illnesses. All laboratory prameters were normal except an unconjugated hyperbilirubinemia. A diagnosis of Gilbert syndrome was made after careful clinical evaluation.<br>CONCLUSION: Recognizing Gilbert syndrome has important clinical implicaitions by avoiding uncessary and expensive workup of patients with jaundice. Mangement entails avoiding stressful conditions and prolonged fasting.&nbsp;</p> Amir Sultan, Kibrewossen Kiflu Copyright (c) Fri, 01 Jan 2021 00:00:00 +0000