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Shiferaw Letta,1 Fekadu Aga,2 Tesfaye Assebe Yadeta,1 Biftu Geda,3 Yadeta Dessie4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia; 4School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Shiferaw Letta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia, Tel +251911771934, Email shife1973@gmail.comBackground: Diabetes, together with its complications, has a considerable negative influence on people’s quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia.Methods: A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤ 0.05.Results: One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥ 5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications.Conclusion: The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.Keywords: chronic complications, type 2 diabetes, Harar, Eastern Ethiopia

Shiferaw Letta,1 Fekadu Aga,2 Tesfaye Assebe Yadeta,1 Biftu Geda,3 Yadeta Dessie4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia; 4School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Shiferaw LettaSchool of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, EthiopiaTel +251911771934Email shife1973@gmail.comBackground: All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient’s health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients’ self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia.Methods: Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question.Results: Researchers identified barriers to diabetes patients’ self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers.Conclusion: Multi-level barriers to diabetes patients’ self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers’ and patients’ capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders’ engagement and one-to-one or group interventions covering the multi-level challenges.Keywords: diabetes, self-care, barriers, health care providers, holistic care, Eastern Ethiopia

Background: Community-based health insurance is a voluntary scheme where community members pool resources to cover healthcare costs. Assessing beneficiary satisfaction with chronic disease management is crucial for the program's long-term viability. Therefore, this study aimed to assess determinants of satisfaction with community-based health insurance among beneficiaries with chronic diseases in selected public hospitals in the Hararghe Zones of Eastern Ethiopia., Methods: An institution-based cross-sectional study was conducted among randomly selected 416 chronic disease beneficiaries of community-based health insurance from 30 July to 30 August 2023. Data were collected through a pre-tested and structured face-to-face interview questionnaire. The data were entered into Epi-Data 3.1 and then exported to STATA 17.0 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify determinants of satisfaction with community-based health insurance. Significance was set at a p -value < 0.05., Results: The mean age of the study participants was 48.10 ± 15.8 years. The study revealed that 55.1% (95% CI: 50.2%-59.8%) of beneficiaries with chronic diseases were satisfied with community-based health insurance. Beneficiaries aged over 55 years (AOR = 0.27; 95% CI: 0.08-0.91), experiencing delayed community-based health insurance opening times (AOR = 0.35; 95% CI: 0.17-0.73), preferring hospitals for future services (AOR = 4.13; 95% CI: 1.14-14.85), shorter waiting times (<60 min) (AOR = 8.8; 95% CI: 4.39-17.72), availability of drugs (AOR = 2.67; 95% CI: 1.30-5.45), availability of laboratory services (AOR = 5.5; 95% CI: 2.83-10.84), and knowledge of community-based health insurance benefit packages (AOR = 2.8; 95% CI: 1.47-5.43) were significant determinants associated with satisfaction to the community-based health insurance service., Conclusion: About half of the community-based health insurance beneficiaries with chronic diseases were satisfied, indicating that a considerable number of them were dissatisfied with the services. The age of the participants, office opening time, waiting times, laboratory services, pharmacy services, and knowledge of community-based health insurance benefit packages were significant determinants of satisfaction with community-based health insurance schemes. Therefore, the government and other stakeholders need to enhance service quality, increase awareness, and address both supply and demand-side factors. These key strategies can lead to higher satisfaction with and ensure the sustainability of community-based health insurance schemes., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The Ethiopian Ministry of Health (EMOH) has recently introduced a Continuous Professional Development (CPD) program for healthcare workers to ensure they maintain the necessary competencies to meet the community's health needs. However, there is limited information on healthcare workers' knowledge and perceived need for CPD. This study aims to assess healthcare workers' CPD knowledge, perceived needs, and factors associated with these in eastern Ethiopia., Methods: A health facility-based cross-sectional quantitative study was conducted from September 1, 2022, to October 30, 2022. Health facilities and study participants were selected using a simple random sampling technique. A total of 731 healthcare professionals were randomly selected. Data was collected using a self-administered questionnaire developed from national CPD guidelines. Data analysis was performed using the STATA statistical package version 14. A logistic regression model was used to assess the association between predictors and the outcome variable. Adjusted odds ratios with 95% confidence intervals were calculated to determine the strength of the association. A p-value < 0.05 was considered statistically significant., Results: In this study, 731 healthcare workers participated. Among them, 65.80% (95% CI: 62.35%, 69.24%) had knowledge of CPD, and 79.48% (CI95% 76.54, 82.41) expressed a strong perceived need for CPD. Female healthcare workers [AOR: 0.54 (95% CI: 0.37, 0.78)] and lack of internet access [AOR: 0.68 (95% CI: 0.47-0.97)] were predictors of knowledge of CPD. Age above 35 [AOR: 0.39 (95% CI: 0.17, 0.91)] and being female [AOR: 0.59 (95% CI: 0.40-0.87)] were predictors of a strong perceived need for CPD., Conclusion: The study found that there was a low level of knowledge about Continuing Professional Development among healthcare workers. The perceived needs of healthcare workers varied. It is important for health sectors and stakeholders to prioritize developing strategies that address knowledge gaps, particularly among female healthcare workers, improve access to the Internet for CPD resources, and address the diverse needs of professionals for effective CPD implementation., (© 2024. The Author(s).)

Background: Healthcare workers must maintain their knowledge, attitude, and skills regarding the most recent technology and competencies to deliver quality health care. The Ministry of Health, Ethiopia developed guidelines and directives for the utilization of continuous professional development programs. However, there is limited evidence on utilization and barriers to utilization in the study area. Therefore, this study aimed to assess the utilization and barriers to the utilization of continuous professional development among health professionals working in health facilities in eastern Ethiopia., Methods: A health facility-based cross-sectional quantitative study was conducted among 731 healthcare professionals from September 01, 2022, and October 30, 2022. A multistage sampling technique was utilized. A simple random sampling technique selected health facilities and study participants. A self-administered questionnaire developed from national continuous professional development guidelines was disseminated to healthcare professionals working in the selected forty health centers and four hospitals. STATA statistical package version 14 was used for data analysis. A descriptive summary was used to summarize the variables. A logistic regression model was used to assess the association between independent variables and the outcome variable. Adjusted odds ratios along with 95% CIs were estimated to assess the strength of the association, and a p-value < 0.05 was used to declare the level of statistical significance in the analysis., Results: Continuous professional development utilization was determined for 731 healthcare professionals, of whom 241 (32.97%) [(95% CI: (29.55, 36.38)] had utilized continuous professional development. Lack of continuous professional development knowledge AOR 0.23 [(95% CI: 0.14, 0.37)], being female AOR 0.58 [(95% CI: 0.39, 0.86)], lack of internet access AOR 0.62 [(95% CI: 0.43, 0.89)], greater than 20 km distance from main road AOR 0.58 [(95% CI: 0.37, 0.91)], not heard importance of continuous educational units AOR 0.45 [(95% CI: 0.31, 0.65)], and poor perceived need of continuous professional development AOR 0.61 [(95% CI: 0.38, 0.97)], had a negative statistically significant association with the utilization of continuous professional development., Conclusion: The utilization of continuous professional development in the study area was low. Health sectors and stakeholders working on continuous professional development programs are required to focus on developing strategies for knowledge creation, female health workers, and access to the internet, remote areas, information on the importance of continuous educational units, and the variety of needs of professionals for continuous professional development implementation., (© 2024. The Author(s).)

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents) and grandmothers (23 respondents) of children aged 6-23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notes before qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuits and lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Objective: To assess diabetes knowledge and foot care practices among type 2 diabetes patients., Design: An institution-based cross-sectional study was undertaken from 1 January to 31 January 2021., Setting: Eastern Ethiopia., Participants: Randomly selected type 2 diabetes patients who were available during the data collection period were included., Outcomes: Patients' diabetes knowledge was assessed with the revised diabetes knowledge test questionnaire. Five items were used to evaluate foot self-care practices., Results: The study population comprised of 549 patients. About 52.5% of the patients had adequate diabetes knowledge (95% CI: 48.2% to 56.7%). Patients with an educational level of secondary school and above (adjusted OR (AOR): 2.04, 95% CI: 1.13 to 3.71), (AOR: 5.28, 95% CI: 2.28 to 12.22), and those with medium and above wealth status (AOR: 3.81, 95% CI: 2.24 to 6.47), (AOR: 3.46, 95% CI: 1.98 to 6.04), were found to have better odds of having adequate diabetes knowledge. However, those aged >55 years (AOR: 0.47, 95% CI: 0.22 to 0.99) were found to have lower odds of adequate diabetes knowledge.Of the total included patients, 20.2% (95% CI: 16.9% to 23.8%) had good foot care practices. Knowledge of the target fasting plasma glucose (AOR: 3.18, 95% CI: 1.94 to 5.22) and adequate diabetes knowledge (AOR: 3.40, 95% CI: 1.95 to 5.91) were significantly associated with good foot care practices., Conclusion: According to this study, about half of individuals with type 2 diabetes have adequate levels of knowledge about the disease. In addition, only one out of every five patients has good foot care habits. Diabetes education should emphasise the significance of rigorous adherence to daily foot care practices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to determine the level of adherence to foot care recommendations and associated factors among people with diabetes on follow-up in public hospitals in Eastern Ethiopia., Setting: An institutional-based cross-sectional study was conducted in public hospitals found in Eastern Ethiopia from 25 February to 25 March 2022., Participants: A total of 419 patients with chronic diabetes who visited diabetic clinics in public hospitals in Eastern Ethiopia for follow-up were included., Main Outcome Measure: The level of adherence to diabetic foot care recommendations and associated factors., Results: The findings indicated that 44.3% (95% CI: 39.3, 49.0) of people with diabetes had inadequate adherence to diabetic foot care recommendations. Age between 28-37 (adjusted OR (AOR)=1.10; 95% CI: 1.27, 5.63) and 38-47 years (AOR=2.19; 95% CI: 2.74, 8.89), rural residence (AOR=1.71; 95% CI: 1.15, 2.57), absence of comorbidity (AOR=2.22; 95% CI:1.34, 5.14), obesity (AOR=1.43; 95% CI: 1.10, 5.05) and inadequate foot care knowledge (AOR=2.10; 95% CI: 1.52, 4.35) were factors significantly associated with inadequate adherence to diabetic foot care recommendations., Conclusion: More than two-fifths of people with diabetes had inadequate adherence to diabetic foot care recommendations. Younger age, rural residence, absence of comorbidity, obesity and inadequate foot care knowledge were significantly associated with inadequate adherence to diabetic foot care recommendations. It is very essential to educate people with diabetes about the importance of foot care recommendations in preventing and delaying the risks of foot-related problems and complications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Shiftwork sleep disorder is one of the most common health-related effects of Shiftwork, particularly among healthcare workers. It is a chronic condition that is directly related to a person's work schedule. In Ethiopia, although a mental health strategy is in place, little attention is given to studies that focus on shiftwork sleep disorders among nurses. This study aimed to determine the magnitude of shiftwork sleep disorder and associated factors among nurses working at public hospitals in Harari Regional State and the Dire Dawa Administration., Methods: Institutional based cross-sectional study was conducted from June 1-30, 2021 among 392 nurses selected by a simple random sampling technique. A structured interviewer-guided self-administered questionnaire was used for data collection. The International Classification of Sleep Disorders 3rd edition (ICSD-3), Bargen Insomnia Scale (BIS) and Epworth Sleepiness Scale were used to assess shift-work sleep disorder. The data were entered into EpiData and exported to SPSS for analysis. Bivariable logistic regression was used to see the association between the outcome and the explanatory variables. Bivariate and Multivariate analyses were performed, and AOR with 95% CI was used to measure the strength of the association. Those variables with a p-values of < 0.05 were considered as statistically significant., Results: In this study, the magnitude of shiftwork sleep disorder among nurses was 30.4% (95% CI: 25.4-34.5). Being female (AOR = 2.4, 95% CI: 1.3, 4.2), working an average number of nights > 11 per month in the last 12 months (AOR = 2.5, 95% CI: 1.3, 3.8), and khat use in the last 12 months (AOR = 4.9, 95% CI: 2.9, 8.7) were significantly associated with the shiftwork sleep disorder., Conclusions: The study revealed that about one-third of the nurses had a shiftwork sleep disorder implying a high burden of the problem among nurses in the study setting, which endangers nurses, patients, and the healthcare system. Being female, working an average number of nights > 11 per month in the last 12 months, and khat use showed statistically significantly associated with the shiftwork sleep disorder. Early detection of shiftwork sleep disorder, having a policy on khat use and considering rest/recovery while scheduling work time should be addressed to prevent shiftwork sleep disorder., (© 2023. The Author(s).)

Background: Canceling elective surgeries is a significant problem in many hospitals leading to patient dissatisfaction, increased costs, and emotional trauma for patients and their families. Despite this, there is limited information about the cancellation of elective surgeries in Ethiopia, mainly in the study area., Objective: This study aimed to assess the magnitude of cancellation and associated factors among patients scheduled for elective surgeries in public hospitals in the Harari Regional State, Eastern Ethiopia, from 1 August to 30 August 2021., Methods: A hospital-based cross-sectional study was conducted on 378 patients scheduled for elective surgeries. Data were gathered using a non-random sequential sampling approach. In addition, a structured face-to-face interviewer-administered questionnaire was employed. The gathered information was input into Epidata version 3.1 and then exported to Statistical Package for Social Software version 26. To find the variables associated with the cancellation of elective surgeries, binary and multi-variable logistic regression analyses were conducted. In the binary analysis, all variables with a p -value of less than 0.25 were included in the multivariable analysis. Finally, a 0.05 p -value with a 95% confidence interval and an adjusted odds ratio was used to declare a significant association., Results: This study included 378 patients scheduled for elective surgeries. Among those, 35.2% of the surgeries were canceled (95% confidence interval: 29.4-39.6). Being female (adjusted odds ratio: 2.46; 95% confidence interval: 1.44-4.203), lack of formal education (adjusted odds ratio: 2.03; 95% confidence interval: 1.15-3.58), place of residence (adjusted odds ratio: 1.70; 95% confidence interval: 1.03-2.81), increase in blood pressure (adjusted odds ratio: 5.09; 95% confidence interval:1.90-13.59), and ophthalmologic surgery (adjusted odds ratio: 3.76; 95% confidence interval: 1.41-10.0) were factors associated with the cancellation of elective surgeries., Conclusion: In this study, nearly one third of scheduled elective surgery was canceled. The primary contributing variables to the surgery cancellations were being female, lack of formal education, place of residence, ophthalmologic surgery, and increased blood pressure. Therefore, timely evidence-based reporting through the supervision team was advised to decrease cancellations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Adugna, Worku, Hiko, Dheresa, Letta, Sertsu and Kibret.)

Background: People with hypertension have a high risk of developing mental disorders, such as depression and/or anxiety. However, there is a paucity of data regarding comorbid depression and anxiety symptoms among people with hypertension in study settings., Objective: The study determined the prevalence and associated factors of depression, and anxiety symptoms among people with hypertension on follow-up at public hospitals, in Eastern Ethiopia., Materials and Methods: A cross-sectional study was carried out among 471 people with hypertension who were randomly chosen from four public hospitals in Harar town and the Dire Dawa Administration. The data were collected by interviewer-administered structured questionnaires. A validated nine-item Patient Health Questionnaire and Generalized Anxiety Disorder scales were used to assess depression and anxiety symptoms, respectively. A logistic regression model was used to identify the association among depression, anxiety, and their predictors. An adjusted odds ratio and a 95% confidence interval were used to report the association. The statistical significance was set at a p -value of < 0.05., Results: Depression and anxiety symptoms were present in 27.2 and 32.7% of people with hypertension, respectively. Being women (AOR = 1.74, 1.09-2.78), having no formal education (AOR = 2.19, 1.19-4.81), presence of other medical illnesses (AOR = 2.23, 1.39-3.56), having a family history of depression (AOR = 2.01, 1.25-3.19), and poor social support (AOR = 2.80, 1.60-5.22) were statistically associated with depressive symptoms, whereas being women (AOR = 1.54, 1.01-2.35), widowed and divorced (AOR = 2.22, 1.41-3.52), presence of other medical illnesses (AOR = 1.64, 1.06-2.53), and poor social support (AOR = 3.54, 2.09-6.01) were statistically associated with anxiety symptoms., Conclusion: More than a quarter of people with hypertension reported symptoms of depression and anxiety. Findings demonstrated that being a woman, having an additional medical illness and having poor social support were statistically associated with depressive and anxiety symptoms. Regular screening, early detection, and offering the proper intervention should be on top priorities for healthcare professionals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abdisa, Letta and Nigussie.)

Objective: This study aimed to assess factors associated with poor medication adherence during the COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia., Setting: Hospital-based cross-sectional study was conducted in Harari regional state and Dire Dawa Administration from 1 January to 30 February 2022. Both settings are found in Eastern Ethiopia., Participants: A total of 402 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study., Main Outcome Measures: The main outcome measure was poor medication adherence during the COVID-19 pandemic., Results: The level of poor antihypetensive medication adherence was 63% (95% CI 48.1 to 67.9). Patients who had no formal education (adjusted OR (AOR)=1.56, 95% CI 1.03 to 4.30), existing comorbid conditions (AOR=1.98, 95% CI 1.35 to 4.35), self-funded for medication cost (AOR=2.05, 95% CI 1.34 to 4.73), poor knowledge about hypertension (HTN) and its treatment (AOR=2.67, 95% CI 1.45 to 3.99), poor patient-physician relationship (AOR=1.22, 95% CI 1.02 to 4.34) and unavailability of medication (AOR=5.05, 95% CI 2.78 to 12.04) showed significant association with poor medication adherence during the pandemic of COVID-19., Conclusion: The level of poor antihypertensive medication adherence was high in this study. No formal education, comorbidity, self-funded medication cost, poor knowledge about HTN and its treatment, poor patient-physician relationship, and unavailability of medication during the COVID-19 pandemic were factors significantly associated with poor adherence to antihypertensive medication. All stakeholders should take into account and create strategies to reduce the impact of the COVID-19 pandemic on medication adherence of chronic diseases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Hypertension is a silent killer that causes serious health issues in all parts of the world. Hypertension is a risk factor for cardiovascular disease, stroke, and kidney disease. Self-care practices have been identified as an important component of hypertension management. Despite the government's commitment and the interventions of various stakeholders, the burden of hypertension and its sequel remain unabated. A recent study showed that hypertension self-care practices play a vital role in controlling and managing high blood pressure, even though there is poor self-practice among hypertensive patients in Ethiopia. Therefore, this study assessed the level of self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City Administration, Eastern Ethiopia., Methods: Hospital-based cross-sectional study was conducted from June 15 to July 15/2021 among 415 adult hypertensive patients on follow-up. The participants were selected using systematic sampling. Hypertension Self-Care Activity Level Effects (H-SCALE) was used to collect data through face-to-face interviews. The SPSS version 24 was used for analysis. Logistic regression analyses were done to determine the association between the outcome and independent variables. For multivariate logistic regression models, variables having a P < 0.25 during bivariate analysis were candidates. The strength of the association was estimated using AOR and 95% CI. The level of statistical significance was declared at a p < 0.05., Results: This study revealed that 52% (95% CI, 48.2-58%) had good level of self-care practices. Formal education (AOR = 3.45, 95% CI: 2.1-4.85), good knowledge about hypertension (AOR = 1.5, 95% CI: 1.17-2.1) 1.5, abstain from chewing khat (AOR = 2.01, 95% CI: 1.44-3.94), strong social support (AOR= 1.9, 95% CI: 1.16-3.1), and absence of depression (AOR = 2.03, 95% CI: 1.43-3.92) were statistically associated with a good level of self-care practices., Conclusions: This study pointed out that about half of the participants had a good level of self-care practices. Formal education, good knowledge about hypertension, abstaining from khat chewing, good social support, and absence of depression showed associations with a good level of self-care practices. Therefore, public health interventions on hypertension self-care practices, and strengthening non-communicable diseases control programs are vital. Moreover, the provision of targeted education to patients can improve disease knowledge and self-care practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abdisa, Balis, Shiferaw, Debella, Bekele, Girma, Mechal, Amare, Kechine, Tari, Nigussie, Assefa and Letta.)

Introduction: Even though optimal blood glucose control reduces the risk of diabetes-related complications, many patients with type 2 diabetes (T2D) fail to achieve it for a variety of reasons. In the study area, there was a paucity of evidence regarding correlates of glycemic control. Therefore, this study aimed to find out the correlates of glycemic control among patients with T2D in Eastern Ethiopia., Methods: A cross-sectional study was conducted among 879 adult patients with T2D on follow-up at two public hospitals in Harar. Data were collected through interviews, physical measurements, and record reviews. The level of glycemic control was determined from three consecutive fasting plasma glucose (FPG) measurements. A mean value of FPG measurements falling in the normal range (80-130 mg/dl) was considered as optimal glycemic control; otherwise, a mean FPG level that is below or above the normal range (<80 mg/dl or >130 mg/dl) was defined as suboptimal glycemic control. Descriptive statistics were used to summarize the data, while a linear regression model was used to find out the correlates of glycemic control. A beta coefficient and a 95% CI reported associations. The statistical significance was declared at a p-value ≤0.05., Results: The mean age of the patients with T2D was 52.7 ( ± 13.3) years. The mean FPG level was 172 ± 56 mg/dl. Suboptimal glycemic control was found in 76% (95% CI: 73.41, 79.04) of patients with T2D. In a multivariable linear regression, khat chewing (β = 6.12; 95% CI: 1.55, 8.69), triglycerides (β = 0.56; 95% CI: 0.41.48, 0.65), comorbidity (β = 5.29; 95% CI: 1.39, 9.13), and poor level of self-care practices (β = 5.43; 95% CI: 1.41, 6.46) showed a significant correlation with glycemic control., Conclusions: This study found that about three-fourths of patients with T2D had suboptimal glycemic control. Khat chewing, comorbidity, and poor level of self-care practices were independently correlated with glycemic control. Thus, suppressing glycemic levels through appropriate treatment and strict diabetes self-care practices including avoidance of Khat chewing is a useful approach to attaining glycemic target that subsequently reduces cardiovascular risks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Letta, Aga, Yadeta, Geda and Dessie.)

Objective: This study investigated the level and correlates of self-care practices among patients with type 2 diabetes on follow-up in two public hospitals in Harar, Eastern Ethiopia., Methods: We conducted a hospital-based cross-sectional study on adult patients with type 2 diabetes, surveying diabetes self-care practices using a 15-item Summary of Diabetes Self-Care Activities. Responses ranged from 0 to 7 days, and a composite score was computed representing the mean days of diabetes self-care practices. A generalized Poisson regression model with robust variance was used. The association between the diabetes self-care practices and correlates was examined using the incidence rate ratio with a 95% confidence level. The statistical significance was set at a p value of ⩽0.05., Results: This study included 879 patients with type 2 diabetes. The overall mean (standard deviation) diabetes self-care practices were 3.7 ± 1.1 days out of the recommended 7 days, indicating low self-care practices. After controlling for other variables, tertiary educational level (incidence rate ratio = 1.06; 95% confidence interval: 1.01, 1.12), adequate diabetes knowledge (incidence rate ratio = 1.04; 95% confidence interval: 1.00, 1.08), moderate (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11) and high perceived self-efficacy (incidence rate ratio = 1.14; 95% confidence interval: 1.09, 1.13) (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11), high to marginal food security (incidence rate ratio = 1.13; 95% confidence interval: 1.03, 1.24), and receiving dietary advice (incidence rate ratio = 1.11; 95% confidence interval: 0.06, 1.15) were positively correlated with diabetes self-care practices. A history of hospitalization, on the other hand, was found to be inversely correlated with diabetes self-care practices (incidence rate ratio = 0.94; 95% confidence interval: 0.88, 0.99)., Conclusion: The study indicated that adherence of patients with type 2 diabetes to the recommended self-care practices was considerably low. Therefore, tailored diabetes self-management education to enhance self-efficacy and diabetes self-care practices must be in place. This can be achieved through the system or individual-based integrated intervention efforts., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: Sustained adherence to highly active antiretroviral therapy is necessary to suppress viral replication and improve immunological and clinical outcomes. Although different studies tried to identify factors affecting adherence to highly active antiretroviral therapy, there are few studies after initiation of test and start strategy and the first-line drug regimen change in the study area. Therefore, this study aimed to determine the level of adherence to highly active antiretroviral therapy and associated factors among people living with HIV in Eastern Ethiopia., Methods: Institutional-based cross-sectional study design was conducted from 2 March 2020, to 30 March 2020. A total of 501 study participants were recruited using systematic random sampling. Data were collected using face-to-face interviews at the end of the clinic visit and a review of participants' medical records. The level of adherence to highly active antiretroviral therapy was measured using the eight-item Morisky Medication Adherence Scale. The score ranges from 0 to 8, and a score of less than 8 indicates poor adherence. The data were entered into EpiData and exported to STATA for further analysis. The binary logistic regression analysis model was employed to identify associated factors. The association was reported with an adjusted odds ratio and a 95% confidence level. The significance level was declared at p = 0.05., Results: A total of 501 participants participated in the study, giving a response rate of 98.2%. The majority (314 or 62.7%) of study participants were females. The participants' mean (standard deviation) age was 38.17 (8.75). The level of poor adherence to highly active antiretroviral therapy was found to be 33.73% (confidence interval: 29.70, 38.00). Age category 35 to 44 (1.65 (confidence interval: 1.02, 2.69)), no shortage of highly active antiretroviral therapy (0.46 (confidence interval: 0.28, 0.75)), substance use (1.67 (confidence interval: 1.11, 2.25)), having moderate depressive symptoms (4.00 (confidence interval: 1.94, 8.48)), and moderate anxiety symptoms (5.22 (confidence interval: 2.31, 8.84)) were significantly associated with the poor adherence to highly active antiretroviral therapy among adult people living with HIV., Conclusion: The level of poor adherence to highly active antiretroviral therapy was found to be high in this study. Poor adherence to highly active antiretroviral therapy was significantly associated with age, availability of highly active antiretroviral therapy drugs, substance usage, depressive symptoms, and anxiety symptoms. Improving the adherence levels requires stringent counseling, assuring continuous drug availability, and timely screening and management of depression and anxiety., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: The aim of this study was to assess the magnitude of uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at public hospitals in Eastern Ethiopia., Methods: A hospital-based cross-sectional study was conducted among 415 hypertensive patients in Eastern Ethiopia from June 15 to July 15, 2021. A systematic random sampling technique was used to select the study participants. Data were collected through face-to-face interviews and reviewing patients' charts. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with uncontrolled hypertension., Results: This study revealed that magnitude of uncontrolled hypertension was 48% (95% confidence interval = 43.1%-52.8%). Being male (adjusted odds ratio = 2.05, 95% confidence interval = 1.29-3.26), age ⩾55 years (adjusted odds ratio = 3.16, 95% confidence interval = 1.96-5.08), non-adherence to medication (adjusted odds ratio = 1.83, 95% confidence interval = 1.14-2.94), low diet quality (adjusted odds ratio = 4.04, 95% confidence interval = 2.44-8.44), physically inactive (adjusted odds ratio = 3.20, 95% confidence interval = 1.84-5.56), and having comorbidity (adjusted odds ratio = 3.04, 95% confidence interval = 1.90-4.85) were significantly associated with uncontrolled hypertension., Conclusions: In our sample of hypertensive patients on follow-up at public hospitals in Eastern Ethiopia, half had uncontrolled hypertension. Older age, male sex, non-adherence to antihypertensive medication, low diet quality, physically inactive, and having comorbidity were found to be predictors of uncontrolled hypertension. Therefore, sustained health education on self-care practices with special emphasis on older, males, and patients with comorbid conditions., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.

Introduction: Urinary tract infection remains one of the major public health problems among post-fistula patients worldwide, particularly in sub-Saharan Africa. Besides, antimicrobial resistance impedes the effective infection prevention and treatment of ever-increasing bacteria. There was a paucity of data on urinary tract infections and the antimicrobial susceptibility profile of bacteria among post-fistula patients., Objective: To determine the prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among women with post-fistula attending public health facilities, Harar, eastern Ethiopia., Methods: An institutional-based cross-sectional study was conducted among 146 consecutively enrolled women with post-fistula from February 2017 to December 2018. Risk factors were collected using a structured questionnaire. The midstream urine was collected, cultured and bacteria species were identified by using standard culture methods. Antimicrobial susceptibility testing was done by the disk diffusion technique. The association between independent and outcome variables was computed by using logistic regression analysis. A p -value < 0.05 was considered statistically significant., Results: The prevalence of urinary tract infections was 28.8% (95% confidence interval: 23.4, 33.6). Escherichia coli (19.1%), Pseudomonas aeruginosa (14.3%), and Proteus species (11.9%) were the commonest isolates. E. coli showed (75%) resistance to trimethoprim-sulfamethoxazole, amoxicillin (62.5%), and ciprofloxacin (62.5%). Staphylococcus aureus was shown 80% resistance to amoxicillin and erythromycin. Giving birth to a single baby (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.8), illness by a fistula for less than 3 years (adjusted odds ratio: 0.2, 95% confidence interval: 0.1, 0.6), and lack of a previous history of catheterization (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.9) decrease the odds of having urinary tract infections., Conclusion: Gram-negative organisms were the commonest cause of urinary tract infections in women with post-fistula. E. coli and P. aeruginosa showed higher resistance to most antimicrobials in the panels. Fistula patients need to be screened for urinary tract infections before antimicrobial treatment is indicated., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Introduction: Antenatal care offers a forum for critical healthcare functions, including health education, screening, and disease prevention. Several pocket studies carried out in specific localities of East African countries were investigated. However, these were neither representative of the country nor specific to the recommended minimum of four antenatal care visits. Therefore, this study aimed to identify factors associated with quality of antenatal care among pregnant women in East Africa., Methods: A secondary data analysis was done using Demographic and Health Survey data of six East African Countries from 2008 to 2018. A total of 46,656 women who gave birth in the 5 years preceding the survey were included in this study. A multilevel mixed-effect logistic regression model was fitted. Variables with a p-value < 0.05 were declared as significant factors associated with the quality of antenatal care., Results: The magnitude of quality of antenatal care in East Africa was 11.16% (95% confidence interval: 10.87-11.45). Women of age 35-49 (adjusted odds ratio = 1.51; 95% confidence interval: 1.25-1.80), primary education (adjusted odds ratio = 1.35; 95% confidence interval: 1.18-1.55), richest wealth index (adjusted odds ratio = 2.35; 95% confidence interval: 2.02-2.74), and rural resident (adjusted odds ratio = 0.62; 95% confidence interval: 0.55-0.69) were among factors significantly associated with quality of antenatal care., Conclusion: The magnitude of antenatal care quality was low in East Africa. Age, level of education, wealth index, birth order, husband/partners' level of education, residence, and living countries were among the factors associated with the quality of antenatal care. It would be useful to increase financial support strategies that enable mothers from poor households to use health services and enhance women's understanding of the significance of antenatal care utilization through health education targeting both women and partners with no education is very crucial.

Achieving the optimal transition to a family diet over the first two years of life has remained a challenge in Ethiopia. The use of amylase-rich flour (ARF) can improve complementary foods. However, utilisation requires an effective delivery strategy for upskilling the community to use ARF. The aim of this study was to explore facilitators and barriers of cascading ARF skills to improve complementary foods. The study was conducted in Gale Mirga kebele of Kersa district in Eastern Ethiopia in 2016. The study utilised exploratory qualitative research that used participatory action. Focus group discussions (FGDs) were conducted with the Health Development Army (HDA) leaders, religious leaders, and observation of participatory complementary food demonstrations. Cultural acceptability and the presence of HDA structure that supports skill development were identified as key facilitators to ARF use. On the other hand, the potential barriers to expanding ARF skill were lack of sustainability of external skill support for HDA leaders, perceived time constraints, unsuitable demonstration settings, cooking method, and large group size. The indigenous community's knowledge of germination has not been used to improve complementary foods. The universal use of ARF requires integration into the Health Extension Programme (HEP) with support and supervision for HDA leaders.

Background: Urinary tract infection is one of the most common health problems worldwide, afflicting many women in reproductive age, especially in developing countries. Increased risk of infection has been attributed to pregnancy and antimicrobial resistance., Objective: To compare the prevalence, antimicrobial susceptibility pattern of the bacteria and associated factors of urinary tract infections among pregnant and nonpregnant women attending public health facilities, Harar, Eastern Ethiopia., Methods: A health facility-based comparative cross-sectional study was conducted among 651 randomly selected women from public health facilities, Harar, Eastern Ethiopia, between February 2017 and December 2017. Pertinent data were collected through a face-to-face interview using a structured questionnaire. The midstream urine specimen was collected and cultured on cysteine-lactose-electrolyte-deficient agar and blood agar. Pure isolates were tested against the ten most prescribed antimicrobials using the Kirby-Bauer disk diffusion method. Data were entered and analysed using Statistical Program for Social Sciences version 21. A p value <0.05 was considered statistically significant., Results: The overall prevalence of significant bacteriuria was 23% (95% CI: 13.6, 26.8). The higher proportion of bacteria were isolated from pregnant women (14.1%) compared to nonpregnant women (8.9%). Escherichia coli (28.8%) and Streptococcus aureus (14.3%) were the most common isolates. E. coli was resistant to amoxicillin (83.3%), trimethoprim-sulfamethoxazole (78.6%), and ciprofloxacin (81%), whereas S. aureus was resistant to chloramphenicol (81%), erythromycin (81%), and amoxicillin (76.2%). Current symptoms, and history of catheterization increase the likelihood of urinary tract infections., Conclusion: Pregnant women were more likely infected with bacterial pathogens than nonpregnant women. Current symptoms, and catheterization increase the odds of urinary tract infections. More than half of the isolates were resistant to the commonly prescribed antimicrobials. Regular assessment of urinary tract infections and antimicrobial resistance are recommended to provide effective therapy and thereby prevent urinary tract complications., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Degu Abate et al.)

Background: To attain a successful treatment outcome, Antiretroviral Therapy (ART) treatment for people living with HIV requires more than 95% adherence level. The adherence level varies depending on different population contexts. Thus, the objective of this study was to investigate ART adherence level among HIV positive patients attending their clinical care in public health facilities in Harar and Dire Dawa, Eastern Ethiopia., Methods: We conducted a cross-sectional study among 626 ART attendees. Data were collected using a structured questionnaire with a face-to-face interview. ART adherence was considered when taking all antiretroviral treatment in a correctly prescribed doses at a right time (no dose missed or delayed for greater than or equal to 90 min) in the week prior to the study. Multivariable logistic analysis was applied to examine the association between the dependent and independent variables. Statistical significance was set at p-value <0.05., Results: The level of ART adherence was 85%. Adherence was more likely among patients of 35-44 years (AOR = 2.39; 95% CI = 1.15-5.01), had monthly income of 501.00-999.00 Ethiopian Birr (ETB) (AOR = 6.73; 95% CI = 2.71-16.75), no history of opportunistic infection (AOR = 2.81; 95% CI = 1.47-5.36), and had good family support (AOR = 2.61; 95% CI = 1.45-4.72). However, those who did not disclose their sero-status (AOR = 0.45; 95% CI = 0.21-0.97) and did experience depression (AOR = 0.36; 95% CI = 0.21-0.61) were less likely adherent than their counter parts., Conclusions: The level of ART adherence was sub-optimal. Concerted and collaborative efforts through effective and efficient interventions are needed in view of the identified factors in order to improve the adherence level.