Intention to use condom among students in Agena preparatory school,Guraghe Zone,Ethiopia: with the application of health believe model

Background

HIV/AIDS is affecting the majority of the population, particularly the productive age group between 15–49 years resulting in social and economic crisis. The rate of HIV infection would undoubtedly be lowered if safe sexual practices such as correct and consistent use of condoms had been followed. The aim of this study was therefore to assess intention to use condom among students in Agena preparatory school, Guraghe zone, Ethiopia. Agena is an urban area in south Ethiopia.

Methods

Institution based cross-sectional study was conducted. A two stage sampling was applied by stratifying students in to (grade 11 and 12) with each grade having four section (A, B, C, D). Then systematic random sampling was used to select students in each section. Analyses of frequencies and summary measures like mean and Standard Deviation of selected variables were done. Bivariate and multivariate analysis was done to measure the association between different variables.

Results

Out of 450 respondents 122(27.1%) had history of sexual intercourse. Of whom the majority 86(70.5%) had two or more sexual partners. And 45(37%) never used condom, 12(9.8%) used condom sometimes and 65(53.2%) used condom every time during sex. About 300(67.7%) of the respondents have no intention to use condom in the next sexual encounter. On multivariate analysis those students who have high perceived susceptibility (AOR = 1.94 (1.16-3.2)) and high self-efficacy (AOR = 27 (14.4-54.2)) were more likely to have intention to use condom than others.

Conclusions

Intention to use condom in the next sexual intercourse is very low. Information Education and Communication (IEC) on reducing number of sexual partners along with condom use promotion targeting in-school adolescents should be the primary strategy of HIV/AIDS prevention process.     

Prognostic Performance of Metabolic Indexes in Predicting Onset of Type 1 Diabetes

OBJECTIVE

In this investigation we evaluated nine metabolic indexes from intravenous glucose tolerance tests (IVGTTs) and oral glucose tolerance tests (OGTTs) in an effort to determine their prognostic performance in predicting the development of type 1 diabetes in those with moderate risk, as defined by familial relation to a type 1 diabetic individual, a positive test for islet cell antibodies and insulin autoantibody, but normal glucose tolerance.

RESEARCH DESIGN AND METHODS

Subjects (n = 186) who had a projected risk of 25–50% for developing type 1 diabetes within 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial–Type 1. Prognostic performance of the metabolic indexes was determined using receiver operating characteristic (ROC) curve and survival analyses.

RESULTS

Two-hour glucose from an OGTT most accurately predicted progression to disease compared with all other metabolic indicators with an area under the ROC curve of 0.67 (95% CI 0.59–0.76), closely followed by the ratio of first-phase insulin response (FPIR) to homeostasis model assessment of insulin resistance (HOMA-IR) with an area under the curve value of 0.66. The optimal cutoff value for 2-h glucose (114 mg/dl) maintained sensitivity and specificity values >0.60. The hazard ratio for those with 2-h glucose ≥114 mg/dl compared with those with 2-h glucose <114 mg/dl was 2.96 (1.67–5.22).

CONCLUSIONS

The ratio of FPIR to HOMA-IR from an IVGTT provided accuracy in predicting the development of type 1 diabetes similar to that of 2-h glucose from an OGTT, which, because of its lower cost, is preferred. The optimal cutoff value determined for 2-h glucose provides additional guidance for clinicians to identify subjects for potential prevention treatments before the onset of impaired glucose tolerance.Early disease prediction and prevention are some of the most important strategies in health care. Preventative care can substantially decrease mortality and morbidity and significantly reduce public health costs (1,2). As genetic/familial factors and autoimmune factors have become available to screen subjects for the risk of developing type 1 diabetes, early intervention trials for this disease have become a reality (3–7). The characterization of this risk may be refined by additional factors to more precisely target individuals who would benefit from preventative treatment. To most accurately select individuals who are at risk for developing disease, beyond screening for antibodies and genetic factors, metabolic risk indicators are being investigated for the development of a more effective clinical prognostic index (8–12).The principal metabolic indexes currently being evaluated as prognostic indicators for type 1 diabetes have been focused on measurements from oral glucose tolerance tests (OGTTs) and intravenous glucose tolerance tests (IVGTTs). Previous research from the Diabetes Prevention Trial–Type 1 (DPT-1) has indicated that some metabolic indexes derived from an OGTT provide substantial predictive value in receiver operating characteristic (ROC) area under the curve (AUC) analysis (13). IVGTT-derived indexes, such as first-phase insulin response (FPIR), homeostasis model assessment of insulin resistance (HOMA-IR), and FPIR-to–HOMA-IR ratio have also demonstrated prognostic value (14–16). However, indexes from both methods have not been compared for predictive accuracy in moderate-risk subjects who are antibody-positive and have genetic risk factors but do not have impaired glucose tolerance. Because subjects in this population who would develop disease are in an early stage of disease progression, they are an important subgroup to target for preventative intervention. If OGTT or IVGTT measurements produce superior predictive indexes compared with each other, costs in future trials can be reduced by relying on a single method of measurement that produces the greatest predictive accuracy.In addition to determining the superior testing method for producing predictive indexes (OGTT vs. IVGTT), there also remains a need to produce effective prognostic thresholds to select between individuals who will progress to disease and who will not, because screening tests for familial, genetic, and immunoglobin risk factors are not precise enough to accurately select subjects, particularly those at an early stage of disease progression who do not exhibit impaired glucose tolerance. Future intervention trials will depend on a refined selection tool to choose subjects for early intervention to ensure an accurate characterization of treatment effects. Optimal cutoff values derived from ROC AUC analysis from metabolic indexes would provide valuable guidance for clinicians and researchers in evaluating patient risk for progressing to type 1 diabetes by providing a threshold, above which the risk is characterized with greater precision than is provided by their underlying risk factors.In this investigation, we assessed the prognostic accuracy of nine metabolic indexes for predicting the progression to clinical onset of type 1 diabetes over a 5-year period using the data from DPT-1. The optimal cutoff values of metabolic indexes were determined to provide previously unavailable guidance to clinicians and researchers in selecting patients likely to progress to disease, who are therefore candidates for early preventative intervention.     

Growing Ignorance of COVID-19 Preventive Measures in Ethiopia: Experts' Perspective on the Need of Effective Health Communication Strategies

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 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.     

Self-care behavior and associated factors among patients with heart failure in public hospitals of Southeast Ethiopia

ObjectiveThis study was performed to assess self-care behavior and associated factors among patients with heart failure attending public hospitals in Southeast Ethiopia in 2021.MethodsAn institutional-based cross-sectional study was conducted among 420 patients with heart failure from 15 May to 30 June 2021 using a simple random sampling technique. A multivariable binary logistic model was used to identify factors associated with self-care behavior. Statistical significance was declared at p < 0.05.ResultsThe magnitude of good self-care behavior among patients with heart failure was 53.6% [95% confidence interval (CI), 48.9–58.3]. Factors associated with self-care behavior were treatment with a beta blocker [adjusted odds ratio (AOR), 0.49; 95% CI, 0.27–0.89], treatment with digitalis (AOR, 0.11; 95% CI, 0.05–0.24), the level of social support (AOR, 0.07; 95% CI, 0.03–0.15), and the presence of depressive symptoms (AOR, 0.21; 95% CI, 2.70–8.33).ConclusionSlightly more than half of the respondents had good self-care behavior. Attention should be given to enhancing good self-care practice through integration of health education as routine care.     

Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia

Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan–Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P < 0.01, respectively), advanced disease stage (WHO clinical stages III and IV; HR: 10.13: 95% CI: 2.25, 45.58; P = 0.003), poor ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.     

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Background and objectives: The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure (BP) recordings is imprecise and biased and has poor test-retest reliability. The use of intradialytic BP measurements to diagnose hypertension is unknown.Design, setting, participants, & measurements: A diagnostic-test study was done with interdialytic ambulatory BP as reference standard. Index BP recordings tested were: predialysis (method 1), postdialysis (method 2), intradialytic (method 3), intradialytic including predialyis and postdialysis (method 4), and the average of predialysis and postdialysis (method 5). Each index BP was recorded over six consecutive dialysis treatments.Results: There were differences among index BP measurements in reproducibility, bias, precision, and accuracy. Method 4 was the most reproducible (intraclass correlation coefficient = 0.70 for systolic and diastolic BP). All 5 measurement methods overestimated 44-h ambulatory systolic BP. Methods 2, 3, or 4 overestimated ambulatory systolic BP by only a small amount. Method 4 was the most precise and accurate. For diagnosis of hypertension, BP cut-point by method 4 of 135/75 mmHg, had a sensitivity of 90.4% and specificity of 75.9% for systolic BP (area under ROC curve 0.90). Median cut-off systolic BP of 140 mmHg from a single dialysis provides approximately 80% sensitivity and 80% specificity in diagnosing systolic hypertension; a median cut-off diastolic BP of 80 mmHg provides approximately 75% sensitivity and 75% specificity in diagnosing diastolic hypertension.Conclusions: Consideration of intradialytic BP measurements together with predialysis and postdialysis BP measurements improves the reproducibility, bias, precision, and accuracy of BP measurement compared with predialysis or postdialysis measurements.The diagnostic and prognostic significance of hypertension among hemodialysis patients continues to be debated (1,2). Whereas many have suggested that blood pressure (BP) recordings are of little value in managing cardiovascular risk (3,4), others have argued that BP control is important (2,5,6). The accurate measurement of arterial pressure is the essential first step in managing this cardiovascular risk factor, yet the diagnosis of hypertension in hemodialysis patients continues to be a vexing problem (7,8).Although home BP monitoring is a superior tool to diagnose hypertension, typically BP measurements obtained just before and after dialysis are used to diagnose and treat hypertension in hemodialysis patients (8,9). However, predialysis and postdialysis BP measurements are generally inaccurate estimates of ambulatory BP measurements (10). In the dialysis unit, BP measurements are obtained every 30 min during dialysis, primarily to ensure the hemodynamic stability of patients during treatment. But the BP measurements so obtained are usually ignored when making a diagnosis of hypertension. The utility of intradialytic BP measurements in diagnosing hypertension among hemodialysis patients therefore remains unknown.The purpose of our study was to evaluate the usefulness of intradialytic BP in diagnosing hypertension among hemodialysis patients. We measured the utility of intradialytic BP by comparing the dialysis-to-dialysis reproducibility and comparing the bias, precision, and accuracy of intradialytic BP measurements to the reference standard of interdialytic ambulatory BP recordings. Finally, we constructed receiver-operating characteristic (ROC) curves to determine clinically useful cut-points and to assess the diagnostic performance of intradialytic BP recordings.     

Occurrence of Pneumocystis carinii in HIV-positive patients with suspected pulmonary tuberculosis in Ethiopia

OBJECTIVE: To investigate the prevalence of Pneumocystis carinii in consecutive HIV-positive patients with suspected pulmonary tuberculosis (PTB) attending a university hospital in Ethiopia. METHODS: A PCR for P. carinii and an indirect immunoflorescence (IF) assay were performed on expectorated sputum samples from: 119 HIV-1-positive patients with negative smears and sputum cultures for Mycobacterium tuberculosis; 96 HIV-1-positive patients with culture-verified PTB; and 97 HIV-negative patients with negative mycobacterial cultures and 72 HIV-negative patients with culture-verified PTB, serving as controls. Outcome of PCR and IF were compared with the chest radiographic (CXR) and initial clinical diagnosis. RESULTS: In the HIV+PTB- group, P. carinii was found in 10.9% by IF, 8.4% by single PCR (sPCR) and 30.3% by nested PCR (nPCR). In the HIV+PTB+ group, 3.1% were P. carinii positive by IF and sPCR and 13.5% by nPCR. All IF- and sPCR-positive samples were nPCR positive. In the HIV-PTB+ and HIV-PTB- groups, 4.2% and 3.1% were nPCR positive, respectively. Six out of eight HIV+PTB- patients with CXR suggesting P. carinii pneumonia (PCP) were IF and/or nPCR positive for P. carinii. In the IF-positive and nested PCR-positive HIV+PTB- patients more than one-third were interpreted as PTB by CXR whereas only one patient was diagnosed with clinical PCP. CONCLUSIONS: P. carinii is prevalent in HIV-positive PTB suspects, suggesting that PCP may be an important, but not well recognized, differential diagnosis. Our findings have implications for treatment and primary prophylaxis for PCP in Ethiopia.     

Deploying artemether‐lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity,mortality and healthcare resources

Objective To assess the impact and feasibility of artemether‐lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia. Methods Two‐year pilot study in two districts: artemether‐lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether‐lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year. Results At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non‐Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1–8.9%) in the intervention district and 20.8% (95% CI: 18.7–23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all‐cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87–1.21, P = 0.751], but risk of malaria‐specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40–0.90, P = 0.013). Conclusions Artemether‐lumefantrine deployment through a community‐based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2‐year period which included a major malaria epidemic.     

Comparison of prostatic volume measured with abdominal ultrasound and prostatic weight determined after open enucleation performed in Gondar University Hospital, Ethiopia

Objective

Benign prostatic hyperplasia (BPH) is a common surgical problem accounting for 20% of elective admissions in our surgical ward. Abdominal ultrasound has been reported as an accurate modality for the measurement of prostatic size. The aim of this study was to evaluate the accuracy of abdominal ultrasound measurement of prostatic size.

Patients and Methods

In this prospective study 53 patients with clinically diagnosed BPH scheduled for enucleation of the prostate underwent pre-operative measurement of the prostate by abdominal ultrasound. Enucleation of the prostate was done via the transvesical approach, and the enucleated tissue was weighed. The results of both measurements were compared using the Epi-Info 2000 software. For the determination of the correlation coefficient we used Fisher’s exact test.

Results

The mean volume of the prostate gland measured by abdominal ultrasound was 68 ± 37.6 cc, while the mean weight of the resected gland was 49.4 ± 29.7 gm (correlation coefficient r=0.72; p= 0.001).

Conclusion

There is a statistically significant correlation between the prostatic volume measured by abdominal ultrasound and prostatic weight determined at open surgery. Abdominal ultrasonography can be used for pre-operative assessment of prostatic size.