The impact of glaucoma on quality of life in Ethiopia: a case-control study.

BACKGROUND: Glaucoma is a chronic disease characterized by irreversible optic nerve damage and visual field loss that leads to visual impairment and blindness; ultimately limiting personal independence and compromising overall quality of life of affected individuals. There is paucity of information on how glaucoma affects the quality of life of patients in low and middle-income countries where resources for both diagnosis and treatment of such conditions are limited. In this study we investigate the impact of glaucoma on quality of life in Ethiopian patients. METHODS: The quality of life of 307 glaucoma patients and 76 normal controls that were frequency matched to the age and sex profiles of the cases was assessed using Amharic version of Glaucoma Quality of Life -15 questionnaire. Linear regression models and the t-test were employed to compare significant differences in GQL-15 scores and to generate mean and mean differences between cases and controls respectively. RESULTS: The mean GQL-15 score in the glaucoma cases was substantially higher (indicating poorer quality of life) than the controls [cases 46.3 (95% CI, 28.8-63.8) and controls 18.6 (95% CI, 15.2-22.0), p < 0.0001]. Cases with normal visual acuity and mild glaucoma had significantly higher scores than the controls. Poorer quality of life was associated with age ≥ 71 years old 51.1 (95%CI, 26.2-75.9), rural residence 55.7 (95%CI, 49.9-61.5), monthly income of <400 Birr (53.1; 95%CI, 50.5-55.6), diagnosis time 1-5 years (49.6; 95%CI, 41.2-57.9), severe visual impairment (70.5; 95%CI, 58.1-82.8), and advanced glaucoma (50.9; 95%CI, 43.6-58.3). CONCLUSION: These glaucoma patients, including those with normal visual acuity and early disease, had poorer quality of life compared to normal controls. Older age, rural residence, low income and more advanced disease were significantly associated with poorer quality of life. There is a need to increase awareness of the impact of glaucoma among clinicians, patients and their families, for a better understanding of the impact this disease has on a person's life

Treatment gap and help-seeking for postpartum depression in a rural African setting

Background Postpartum depression (PPD) affects more than one in ten women and is associated with adverse consequences for mother, child and family. Integrating mental health care into maternal health care platforms is proposed as a means of improving access to effective care and reducing the ‘treatment gap’ in low- and middle-income countries. This study aimed to determine the proportion of women with PPD who sought help form a health facility and the associated factors. Methods A community based, cross-sectional survey was conducted in southern Ethiopia. A total of 3147 women who were between one and 12 months postpartum were screened for depressive symptoms in their home using a culturally validated version of the Patient Health Questionnaire (PHQ-9). Women scoring five or more (indicating potential depressive disorder) (n  = 385) were interviewed regarding help-seeking behavior. Multiple logistic regression was used to identify factors associated independently with help-seeking from health services. Results Only 4.2 % of women (n = 16) with high PPD symptoms had obtained mental health care and only 12.7 % of women (n  = 49) had been in contact with any health service since the onset of their symptoms. In the multivariable analysis, urban residence, adjusted odds ratio (aOR): 4.39 (95 % confidence interval (CI) 1.23, 15.68); strong social support, aOR: 2.44 (95 % CI 1.30, 4.56); perceived physical cause, aOR: 6.61 (95 % CI 1.76, 24.80); perceived higher severity aOR: 2.28 (95 % CI 1.41, 5.47); perceived need for treatment aOR: 1.46 (95 % CI 1.57, 18.99); PHQ score, aOR: 1.14 (95 % CI 1.04, 1.25); and disability, aOR: 1.06 (95 % CI 1.01, 1.15) were associated significantly with help-seeking from health services. More than half of the women with high levels of PPD symptoms (n  = 231; 60.0  %) attributed their symptoms to a psychosocial cause and 269 (69.9 %) perceived a need for treatment. Equal proportions endorsed biomedical treatment and traditional or religious healing as the appropriate intervention. Conclusion In the absence of an accessible maternal mental health service the treatment gap was very high. There is a need to create public awareness about PPD, its causes and consequences, and the need for help seeking. However, symptom attributions and help-seeking preferences indicate potential acceptability of interventions located in maternal health care services within primary care.</p

Coping strategies of women with postpartum depression symptoms in rural Ethiopia:a cross-sectional community study

BACKGROUND: Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions.METHODS: A population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum (n = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, 'high PPD symptoms', (n = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis.RESULTS: Confirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands.CONCLUSIONS: As in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development

Assessment of nutritional status and its associated factors among people affected by human immune deficiency virus on antiretroviral therapy: a cross sectional study in Siltie zone, south Ethiopia

Ethiopia is among the countries most affected by malnutrition and nutrition-related complications remain a challenging issue for Human Immunodeficiency Virus (HIV)- infected patients and those involved in their care. The aim of this study was to assess nutritional status among HIV positive adults in South Ethiopia and assess risk factors for malnutrition in this population. Institution based cross sectional study was conducted among 428 HIV positive adults who are taking ART at 12 health centers, Silte zone, Ethiopia. Convenience sampling technique was used to select the study participants. Structured questionnaire and anthropometric measurements were used to collect data. Data were analyzed using SPSS version 20.0 software. Bivariate and multivariate analyses were used to identify predictors of malnutrition. P-value less than 0.05 were used as cut of point to declare statistical significance. Prevalence of chronic energy deficiency was 24.1%. Food insecurity [AOR= 0.35, 95% CI (0.21, 0.62)], feeding ≤ 2 meals/day [AOR= 0.29, 95% CI (0.29, 0.13)], ambulatory functional status [AOR= 3.4, 95% CI (1.67, 6.98)] and absence of dietary counseling [AOR= 1.7, 95% CI (1.05, 2.78)] were found to be independent predictors of chronic energy deficiency among HIV positive adults. Prevalence of malnutrition is high among HIV infected adults who are on ART in the study area. Regular nutritional assessment of the patients and dietary counseling should be integrated with routine care for HIV/AIDS patients. HIV/AIDS prevention and control programs need to involve nutritionists or trained health care provider to integrate nutritional care services

Perceived occupational stress and associated factors among primary school teachers in the second wave of COVID-19 in Ethiopia: a multicenter cross-sectional survey

BackgroundOccupational stress (OS) is a psychological state that results from people’s perceptions of an imbalance between job demands and their abilities to cope with those demands. The COVID-19 pandemic has disrupted the teaching and learning process and compounded the stress level among teachers due to fear of transmission of the virus and school closures or the difficulty with adherence to the COVOD-19 prevention protocol. This survey study therefore aimed to investigate the prevalence of occupational stress and its associated factors among primary school teachers during the second wave of COVID-19 in western Ethiopia.MethodAn institution-based cross-sectional survey was employed from April to May 2021. The survey was conducted in Gimbi town among all 672 primary school teachers in western Ethiopia. The standardized Teacher Occupational Stress Scale was used to measure occupational stress in the past 4 months. The data were collected through a self-administered questionnaire. The collected data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable logistic regression analysis was conducted to identify factors associated with occupational stress. The statistical significance was considered at a value of p of &lt; 0.05 and a 95% confidence interval (CI) with an adjusted odds ratio (AOR) to evaluate the strength of associations.ResultsThe response rate was 96.8% (N = 651). The majority, 389 (59.8%) of the study participants were males. The mean (±SD) age was 35.8 (±9.3) years. The prevalence of occupational stress in the second wave of COVID-19 in the past 4 months was 50.1% (n = 326) [95% CI (46.1, 53.9)]. Job dissatisfaction [AOR: 2.06, 95% CI (1.43–2.97)] and high-risk perception of COVID-19 infection [AOR: 2.20; 95% CI (1.46–3.31)] were significantly associated with occupational stress.ConclusionThis survey disclosed a high prevalence of occupational stress among primary school teachers during the second wave of COVID-19. Job dissatisfaction and a high-risk perception of COVID-19 infection were significant predictors of the occurrence of occupational stress in school teachers. Enhancing stress management skills and focusing on primary prevention of identified risk factors were advised to curtail the condition

Psychological distress and associated factors among prisoners in North West Ethiopia: cross-sectional study

BACKGROUND: Currently, mental health is an important public health problem and the leading cause of disability worldwide. Studies have shown that, mental illnesses are more common among the prison population than the general population. However, still there is no accurate count of persons with mental disorder who are incarcerated in Ethiopia and information about prisoners’ health conditions is scarce. The purpose of this study was to assess the prevalence and associated factors of psychological distress among prisoner inmates found in prisons of Northwest, Ethiopia. METHODS: Institution based cross sectional study was conducted among 649 prisoners from January to February 2015. Multistage sampling technique was used to select the study participants. Data were collected by using a structured interviewer administered questionnaire. Psychological distress was measured using the Kessler Psychological Distress Scale (K10). Receiver Operating Characteristic curve (ROC curve) analysis was done by STATA version 12 software in order to determine a cutoff point with high sensitivity and specificity. Bivariate and multivariable logistic regression models were fitted to identify associated factors. Adjusted odds ratio with its 95 % Confidence interval was used to declare the statistical significance between psychological distress and associated factors. RESULTS: Prevalence of psychological distress among prisoners was found to be 83.4 % (95 % CI 80.6, 86.0 %). Long duration of stay in the prison (AOR = 0.95; 95 % CI 0.89–0.97), low to no satisfaction with prison services (AOR = 3.01; 95 % CI 1.38–6.51), and place of prison were factors significantly associated with psychological distress among prisoners. CONCLUSION: The prevalence of psychological distress among prisoners was found to be very high. Due attention needs to be given in addressing the mental health needs of the prisoners

Development and validation of a nutrition assessment questionnaire based on the social and behavior change model for adolescents in Ethiopia

BackgroundA reliable assessment of behavior change requires the use of a validated tool based on an appropriate behavior change model. Research on tools for assessing nutrition behavior change is limited.ObjectiveThis study aimed to develop and validate a questionnaire for assessing plant-protein food consumption behaviors based on Pender’s behavior change model, specifically for adolescent girls in Ethiopia.MethodsA collection of items was generated by examining relevant behavior change theories and manuals, dietary guidelines, and literature focused on pulses’ food function, processing, and preparation. The items were examined for content and face validity. Exploratory factor analysis was performed after verifying its assumptions, such as the factorability of the instrument using Bartlett’s test of sphericity and Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy. Eigenvalue and scree plot were used to determine the number of factors. Factor loadings and communalities were employed for item retention. Cronbach’s alpha was calculated to assess the reliability at the scale and dimension levels.ResultsOf the 53 items analyzed, 29 items and 6 factors were retained. The overall scale-level reliability was measured at 0.7210, while the factor-level reliabilities were as follows: 0.69 for factor 1 (i48, i49, i50, i52, i53, i31, and i32), 0.67 for factor 2 (i7, i8, i9, i10, i12, i13, and i14), 0.63 for factor 3 (i23, i24, i25, i26, fi27, and i28), 0.31 for factor 4 (i4, i5, i40), 0.59 for factor 5 (i35, i36, and i37), and 0.58 for factor 6 (i18, i19, and i20).ConclusionThe tool has an acceptable scale-level reliability. The factors are theoretically meaningful and align with the recommendations. The tool can serve as a foundation for developing tools in related fields. However, it requires further refinement before it can be used as a standard tool

Dietary practice and nutritional status and the respective effect of pulses-based nutrition education among adolescent girls in Northwest Ethiopia: a cluster randomized controlled trial

BackgroundThinness and stunting are the most severe public health problems among adolescent girls in Ethiopia. An inadequate intake of protein-source foods is the most critical cause, mainly due to the non-affordability of animal-origin foods. However, research into what extent improving pulses-based food consumption could contribute to decreasing the magnitude of protein-energy undernutrition is limited.ObjectiveThis trial aimed to evaluate the effectiveness of pulses-based nutrition education in reducing the proportion of thinness among adolescent girls.MethodsA two-arm cluster randomized controlled trial was conducted among adolescent girls in Northwest Ethiopia from December 2021 to June 2022. A total of 602 adolescent girls from four schools were enrolled in the trial. Schools were assigned to intervention and control groups using the stratified cluster randomization method. Pulses-based nutrition education was the intervention, whereas the usual dietary practice of adolescent girls was the comparator. The education was delivered over 4 weeks on a 45–60-min session per week basis. Thinness was the primary outcome of the trial, measured by anthropometry. An intention-to-treat analysis method was used. A log-binomial regression model was fitted to the data. Relative risk with the respective confidence interval and value of p was calculated. A value of p &lt; 0.05 was used to declare statistical significance. Stata 16 software was used for the analysis.ResultsAbout 89.37% of the participants in the intervention group and 92.36% in the control group completed the trial. The pulses-based nutrition education intervention did not show a significant difference in reducing the proportion of thinness among the participants in the intervention group compared to the participants in the control group even though a significant difference was observed in terms of the consumption of pulses-based food.ConclusionThe present trial was statistically non-significant in reducing thinness among adolescent girls. Similar studies that utilize objective methods for ascertaining pulses-based food consumption need to be conducted.Clinical trial registration: https://pactr.samrc.ac.za/Search.aspx, the trial was registered in the Pan African Clinical Trials Registry (PACTR202111605102515) on November 12, 2021

Quality of life among people with mental illness attending a psychiatric outpatient clinic in Ethiopia: a structural equation model

BackgroundMental illness is one of the most severe, chronic, and disabling public health problems that affects patients’ Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023.MethodsA facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total study participants who had a follow-up appointment during the data collection period (2400), by the total sample size 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the quality of life (QoL) of people with mental illness. The domains of QoL were identified, and indirect and direct effects of variables were calculated using structural equation modelling with SPSS-28 and Amos-28 software. A p-value of &lt; 0.05 and a 95% CI were used to evaluate statistical significance.ResultsA total of 636 (99.7%) participants agreed to participate and completed the data collection. The mean score of overall QoL of people with mental illness in the outpatient clinic was 49.6 ± 10 Sd. The highest QoL was found in the physical health domain (50.67 ± 9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41 ± 10 Sd). Rural residence, drug nonadherence, suicidal ideation, not getting counselling, moderate or severe subjective severity, family does not participate in patient care and a family history of mental illness had an indirect negative effect on QoL. Alcohol use and psychological health domain had direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having history of mental illness in the family had both direct and indirect effect on QoL. Furthermore, sociodemographic factors (rural residence, illiterate educational status, not married marital status), social support-related factors (poor self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use) and clinical factors (high objective and subjective severity of illness, not getting counselling, suicidal ideation, higher number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL.ConclusionsIn this study, the QoL of people with mental illness was poor, with the psychological health domain the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors, directly and indirectly affected QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the QoL of those with mental illness, including the development of policy and practice responses that address the above identified factors

Mental health service satisfaction among adults with mental illness attending a psychiatric outpatient clinic: a cross-sectional study

BackgroundPatient satisfaction with services is both a direct and indirect indicator of healthcare quality. It influences healthcare outcomes, patient retention, and the likelihood of medical malpractice claims. However, there is limited evidence on patient satisfaction with mental health services in Africa. Therefore, we aimed to assess mental health service satisfaction and its determinants in adult patients with mental illness in an outpatient clinic in Northwest Ethiopia.MethodsA hospital-based cross-sectional study was conducted from October to March 2023. Participants were selected using systematic random sampling with a sample interval of three, resulting in a total sample size of 638 invited to participate. Service satisfaction was measured using the interviewer-administered Client Satisfaction Questionnaire-8 (CSQ-8). Data entry, coding, and analysis were performed using SPSS-28. To examine the association of sociodemographic, clinical, social support, and substance use factors, bivariate and multivariate logistic regression analyses were applied. Statistical significance was declared at a p-value of &lt;0.05 and 95% CI.ResultsThe rate of low mental health service satisfaction among people with mental illness in this study was 24.7%. According to our multivariate logistic regression analysis, people with urban residence 1.77 (1.15, 2.72), poor self-reported health 3.62(1.97, 6.67), having episodic illness ≥2/yr. 0.48 (0.32, 0.74), having relapse 1.75 (1.12, 2.73), and poor drug adherence 2.28 (1.20, 4.35) were more likely to have low mental health service satisfaction than their counterparts.Conclusions and recommendationOne-quarter of patients with mental illness in the outpatient clinic reported low satisfaction with mental health services. Factors associated with lower satisfaction included urban residency, episodic illness, relapse, poor self-reported health, and poor drug adherence. To enhance patient satisfaction, the clinic should prioritize targeted support for patients facing these challenges