Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care

BackgroundEthiopia has been motivated to achieve a goal of “appointment spacing model approach care.” However, little has been documented on the predictor of mortality and challenges of sustainable HIV care. Therefore, the aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART).MethodsA retrospective cohort study was conducted on 676 adult people living with HIV who enrolled to ART clinic from September 01, 2012 - August 30, 2016. Multivariable Cox Regression analysis was done where adjusted hazard ratio (AHR)with corresponding 95% confidence interval (CI) at P value ≤ 0.05 cut of point was used to identify predictors of mortality.ResultsThe total person-time contributed was 28,209 person-months with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). Severe undernourishment and moderate malnutrition at baseline, younger age, female sex, single, divorced, illiterate, lack of disclosure, advanced WHO clinical stage, seeking treatment outside catchment area, rural residence and immunological failure were found to be independent predictors of mortality.ConclusionsPoor nutritional status at baseline, advanced stage of HIV disease, occurrence of treatment failure, female sex, substance abuse, lack of social support, immunological failure, clinical failure, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of the appointment spacing model care can improve survival of PLWHA.     

Thermo-Physiological Comfort Properties of Sportswear with Different Combination of Inner and Outer Layers

Consumers expect high-performance functionality from sportswear. To meet athletic and leisure-time activity requirements, further research needs to be carried out. Sportswear layers and their specific thermal qualities, as well as the set and air layer between materials, are all important factors in sports clothing. This research aims to examine the thermal properties of sports fabrics, and how they are affected by structure parameters and maintained with different layers. Three inner and four outer layers of fabric were used to make 12 sets of sportswear in this study. Before the combination of outer and inner layers, thermal properties were measured for each individual layer. Finally, the thermal resistance, thermal conductivity, thermal absorptivity, peak heat flow density ratio, stationary heat flow density, and water vapor permeability of bi-layered sportswear were evaluated and analyzed. The findings show that sportswear made from a 60% cotton/30% polyester/10% elastane inner layer and a 100% polyester outer layer had the maximum thermal resistance of 61.16 (×10³ K·m² W⁻¹). This performance was followed by the sample made from a 90% polyester/10% elastane inner layer and a 100% polyester outer layer, and the sample composed of a 100% elastane inner layer and a 100% polyester outer layer, which achieved a thermal resistance value of 60.41 and 59.41 (×10³ K·m² W⁻¹), respectively. These results can be explained by the fact that thicker textiles have a higher thermal resistance. This high-thermal-resistance sportswear fabric is appropriate for the winter season. Sportswear with a 90% polyester/10% elastane inner layer had worse water vapor resistance than sportswear with a 60% cotton/30% polyester/10% elastane and a 100% elastane layer. Therefore, these sports clothes have a higher breathability and can provide the wearers with very good comfort. According to the findings, water vapor permeability of bi-layered sportswear is influenced by geometric characteristics and material properties.     

Effect of iron-folic acid supplementation on change of hemoglobin among visceral Leishmaniasis patients in northwest Ethiopia: a retrospective follow up study

Background

An individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients. But there is no documented evidence whether iron-folic acid supplementation improves the hematological profile of patients. Therefore, the study aimed to assess change in hemoglobin (Hb) and its determinant factors among VL patients with and without iron-folic acid supplementation in northwest Ethiopia.

Methods

A retrospective cohort study was conducted from January 2015 to December 2016. Data were entered into Epi-Data version 3.1 and transferred to Statistical Package for Social Science (SPSS) version 20 for analysis. Independent sample T-test and linear regression were used to compare the change in Hb and identify factors associated with a change in Hb, respectively. A 95% confidence level and p-values less than 0.05 were used determine statistically significant.

Results

From a total of 602 VL patients, 299 (49.7%) were from University of Gondar hospital. The mean (±SD) change of Hb from baseline to end of treatment was 0.99(±1.64) and 1.61(±1.88) g/dl with and without iron-folate supplementation, respectively, with mean difference 0.62, 95% CI (0.34, 0.90) and a p-value of <?0.0001. In multiple linear regressions, combination therapy of sodium stibogluconate-paramomycin (SSG-PM) was positively associated with a change of Hb (β [SE, p]: 0.710/0.15, <?0.0001). Whereas age (??0.030/0.009, 0.001), nasal bleeding (??0.261/0.123, 0.035), baseline white blood cell (??0.139/0.044, 0.002) and hemoglobin (??0.513/0.031, <?0.0001), end of treatment spleen size (??0.059/0.015, <?0.0001) and iron-folic acid supplementation (??0.574/0.163, <?0.0001) were negatively associated with change of Hb.

Conclusion

Iron-folic acid supplementation had a negative effect on the change of Hb. A combination therapy of SSG-PM, age, nasal bleeding, baseline white blood cells and Hb, and iron-folic acid supplementation were the determinants of change of Hb. Therefore, avoiding iron-folic acid supplementation and strengthening VL treatment with a combination of SSG-PM and, and early identification of complications is recommended for a better outcome.

     

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center,A Tertiary Hospital in Ethiopia

BackgroundGlobally, 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.MethodsA 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.ResultsOut 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.ConclusionMajority 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.     

Heteronormativity and 'troubled' masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies 'belonging' to parents, families and to society at large.     

Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study

Background  

Eastern Ethiopia hosts a substantial number of refugees originated from Somalia. Female genital mutilation (FGM) is a common practice in the area, despite the campaigns to eliminate it.