College of Health Sciences
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Item DETERMINANTS OF PRECANCEROUS CERVICAL LESIONS AMONG WOMEN SCREENED FOR CERVICAL CANCER IN PUBLIC HOSPITALS OF TIGRAY, ETHIOPIA, 2024. CASE-CONTROL STUDY(Mekelle University, 2025-01-28) HAFTOM BIRHANEBack ground: - Cervical cancer is a common health problem in sub-Saharan countries, mainly in Ethiopia, where a significant number of women are diagnosed, and pre-cancerous lesions are being detected at a late stage, leading to high mortality. The prevalence of precancerous cervical lesions has increased dramatically in Ethiopia (from 7% to 28%), with some regions showing even higher rates. However, the determinants contributing to this rise remain unstudied in Tigray, especially in a case-control study design. Objective: To assess determinants of precancerous cervical lesions among women screened for cervical cancer in public hospitals of Tigray, Ethiopia, 2024. Methods: This study employed a case-control design among (112 cases and 336controls) from August 1 to October 30/2024. Cases and controls were selected by systematic random sampling method and data was collected via a structured questionnaire then data were entered to Epi Data version 4.7 then exported to statistical package for social sciences, p value less than 0.2 in bivariate analysis were included multivariable logistic regression with 95% confidence interval. Finaly p value <0.05 were decided as determinates of precancerous cervical lesions. Result: - Women with a secondary school (AOR=0.044; 95% CI: 0.018-0.107), diploma and above of the women (AOR=0.008; 95% CI: 0.002-0.028), women with two or more life time sexual partners (AOR=9.001, 95% CI: 4.221-19.193), history of STIs, (AOR=3.433, 95% CI: 1.600-7.364) and ever use of hormonal contraceptives (AOR=2.340, 95% CI: 1.220-4.487) were found to be determinates of precancerous cervical lesions. Conclusion and Recommendation: Having two or more lifetime sexual partners, education status of women secondary, diploma, and above, ever use of hormonal contraceptives, and having history of sexual transmission infections were identified as determinants of precancerous cervical lesions. Therefore, efforts should be made to reduce the risk of sexual transmission infections, provide health education and strengthening education for those no formal education women, educate about faithful, one to one relationship, and promote early screening for cervical cancer in women who have ever use hormonal contraceptives.Item Determinants of First-Line Antiretroviral Treatment Failure among HIV Patients Enrolled in ART after Post-war at Alamata General Hospital in Southern Tigray, Northern Ethiopia, 2024(Mekelle University, 2025-01-28) HABTU BERIHUNIntroduction: Antiretroviral therapy (ART) has revolutionized HIV management by targeting different stages of the HIV lifecycle. However, first-line ART failure remains a significant challenge globally, affecting both patients and the healthcare system. In Sub-Saharan Africa, where the HIV epidemic is disproportionately burdened, achieving viral suppression remains a challenge. Factors contributing to ART failure include poor adherence, advanced HIV disease, co-infections, and limited access to viral load monitoring. This can lead to virus replication and resistance, compromising the effectiveness of the initial drug regimen. The recent conflict in Tigray, Ethiopia, has exacerbated the issue, putting a greater strain on the healthcare system and increasing costs. Objective: The aim of this study is to assess the determinants of first-line antiretroviral treatment failure among HIV patients after post-war enrollment in ART at Alamata General Hospital in southern Tigray, in 2024. Methods: An unmatched case control study was conducted among 689 HIV clients enrolled in ART at Alamata General Hospital from May 2024 to September 2024. The study population includes all HIV positive adult patients who were on first-line treatment and controls who met the study criteria. The study will use systematic sampling techniques and structured questionnaires to gather data from medical records and registers of patients on ART. Adherence variables will be categorized into poor, fair, and good adherence. Data quality control established through pre-testing and validation of questionnaires. Data was analyzed using Epi data version 4.2.Softwareand will be exported to SPSS for analysis and a binary logistic regression model to identify variables determining first-line antiretroviral failure. Variables will interpret as having a statistically significant association when the p-value is< 0.05. Results: A study found that a significant number of HIV patients and controls aged 25-34 years were enrolled in antiretroviral therapy (ART). Most were female, married, illiterate, self-employed, and lived below the poverty line. Most patients were on TDF-based ARV regimens at baseline, with a higher proportion in WHO clinical stage 3. A higher proportion of cases developed tuberculosis after starting ART. A significant proportion of cases exhibited poor adherence to ART, with 44.6% being regular coffee drinkers while taking ARV pills. Treatment started with partners, with 59% of cases and 67% of controls starting treatment six months apart. Support groups were involved in 67.4% of cases and 67.4% of controls. Treatment failure rates are higher in individuals aged 25-34, male patients, rural residents, WHO stage III/IV patients, patients with a baseline CD4 count <100 cells/mm³, and those with a BMI <16.5 kg/m². Poor adherence to ART is associated with a 3.6-fold increased risk of failure. Conclusion: In conclusion, this study identified several important determinants of first-line ART failure among HIV patients in post-war settings. Addressing these factors through comprehensive interventions, including early diagnosis, timely initiation of ART, adherence counseling, nutritional support, and conflict-mitigation strategies, is crucial to improve treatment outcomes and reduce the burden of HIV in affected populations.Item DETERMINANTS OF POOR GLYCEMIC CONTROL AMONG ADULT PATIENS WITH TYPE 2 DIABETES MELLITUS ON FOLLOW UP AT THE DIABETIC CLINIC OF REFERRAL HOSPITALS OF TIGRAY, ETHIOPIA, 2025(Mekelle University, 2025-05-28) GIRMAY TEKLEBackground: Poor glycemic control remains a major public health concern among individuals with type 2 diabetes mellitus. In Ethiopia, the prevalence of uncontrolled blood glucose has been reported to range from 45.2% to 73.5%, including findings from studies in the Tigray region. Despite this substantial burden, there is limited research on the specific determinants of poor glycemic control, particularly in the Tigray region. Moreover, most existing studies in Ethiopia have utilized cross-sectional designs, which are limited in establishing temporal relationships between risk factors and glycemic control. A case-control study design offers a more robust approach for identifying these determinants. Therefore, investigating the factors associated with poor glycemic outcomes through a case-control design is essential to guide targeted interventions and strengthen diabetes management strategies. Objectives: The aim of this study was to identify the Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus on follow up at the diabetic clinic of referral hospitals of Tigray, Ethiopia 2025. Methods: An institution-based unmatched case-control study design was conducted between January 15, and February 15, 2025. A total of 250 participants were included, consisting of 84 cases and 166 controls with case-to-control ratio of 1:2. Systematic random sampling was used to recruit cases and controls. Data were collected using an interviewer-administered structured questionnaire via KoBo Toolbox. In bivariable analysis those variables having a P-value of 0.25 were subsequently included in the multivariable. In multivariable analysis at a P-value of 0.05 with 95% confidence interval were considered statistically significant. Descriptive statistics were performed first, with the results summarized using tables, text, and figures. Ethical clearance was secured from the Institutional Review Board of the College of Health Sciences at Mekelle University. Result: This study revealed that inadequate dietary adherence (AOR = 2.59; 95% CI (1.187-5.684)), poor medication adherence (AOR = 2.96 95% CI (1.417–6.207)), presence of comorbidities (AOR = 2.72, 95% CI (1.30–5.69)), and having polypharmacy (AOR = 2.25, 95% CI (1.088- 4.691)) were significantly associated with poor blood sugar control. Conclusion and recommendation: Inadequate dietary adherence, poor medication adherence, co morbidity and having polypharmacy were determinant factors of poor glycemic control. Therefore, we recommend that patients should regularly follow their diet and medication.Item DEPARTMENT OF ADULT HEALTH NURSING DETERMINANTS OF HYPERTENSION AMONG DIABETES MELLITUS PATIENTS IN PUBLIC HOSPITALS OF CENTRAL ZONE TIGRAY, ETHIOPIA 2024 (CASE-CONTROL STUDY)(Mekelle University, 2025-02) GEBREZGABHER HAGOSBackground: Hypertension is defined as a persistent elevation of blood pressure with systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg. Poor diabetes management is a major significant of macrovascular and microvascular complications, as well as death. The gaps were inconsistent in study design and impact of war on health care. Objective: The objective of this study was to identify the determinants of hypertension among diabetes mellitus patients attending in public hospitals of the Central Zone of Tigray, Ethiopia 2024. Methods and materials: An institution-based unmatched case-control design was conducted, among a total sample size of 379 on clients from August 10, October 2024. Systematic random sampling was employed. Data were entered into Epidata version 4.6 and exported to SPSS version 22.0 for analysis. Variables with a p-value < 0.2 in bivariable logistic regression were included in the multivariable logistic regression. A p-value < 0.05 and a 95% confidence interval for the adjusted odds ratio were considered statistically significant determinants of hypertension. Ethical clearance was acquired from Mekelle University College of Health Science's ethical review committee. Results: A total of 379 participants with 1:3, case to controls ratio (95 cases and 284 controls) were included in the study achieving a 100% response rate. The significant factors for the development of hypertension among diabetic were age ≥ 50 years (AOR =6.266, CI 1.777-22.093), long duration of DM (greater than 10 years) (AOR=2.924, CI 1.100-7.771), family history of hypertension (AOR=3.819, CI 1.918-7.605), poor glycemic control (AOR=2.522, CI 1.212- 5.245), high waist to hip ratio (AOR=2.960, CI 1.408-6.220), physicaly inactive (AOR=2.121, CI 1.069-4.211) and poor knowledge about DM (AOR=4.5561, CI 2.308-8.990). Conclusion and Recommendations: Age ≥ 50 years, long duration of DM (above 10 years), Family history of hypertension, Higher waist-to-hip ratio, Poor glycemic control, physicaly inactive and poor knowledge of diabetic mellitus were determinants of hypertension among diabetes mellitus patients. We recommend to health professionals to give health education (about the relationship between obesity, physical inactivity, hypertension, and diabetes).We recommend to the participants to promote physical activity. We also recommended to Tigray Health Bureau to raise awareness among health professionals about the need to monitor patients with diabetes.Item DETERMINANTS OF PREMATURE RUPTURE OF MEMBRANES AMONG PREGNANT MOTHERS ATTENDING PUBLIC HOSPITALS OF CENTRAL ZONE, TIGRAY, ETHIOPIA, 2024; UNMACHED CASE-CONTROL STUDY(Mekelle University, 2025-01-28) GEBREMARIAM KIFLEBackground: Premature rupture of membranes is a condition in which the fetal membranes rupture before the onset of labor and after 28 weeks of gestational age. It complicates 5-10% of all pregnancy, and it is an important cause of perinatal, neonatal, and maternal morbidity and mortality both in developed and developing countries. Though some studies were conducted in Ethiopia on the determinants of premature rupture of membranes there was limited study in the Tigray region, particularly in the study area Objective: To identify determinants of premature rupture of membranes among pregnant mothers admitted to public hospitals in the Central Zone, Tigray, Ethiopia,2024 Methods: A hospital based unmatched case-control study design was conducted from August 1 to September 30, 2024, in public hospitals of Central Zone of Tigray, Ethiopia. All cases admitted at the time of data collection were included until the desired sample size was met, and controls were selected by systematic random sampling. Data were collected using a structured and pre-tested questionnaire by trained midwives then data were entered into Epi Data Version 4.7 and exported to Statistical Package for Social Sciences Version 27. Logistic regression was employed to identify determinant variables. Variables with a p value of less than 0.05 with a 95% confidence interval were used as a statistically significant association in a multivariable logistic regression. Result: A total of 363 participants (121 cases and 242 controls) were included in the study. Rural residence (AOR=2.17,95 % CI: 1.31-3.59, p-value=0.003), having multiple fetus (AOR=2.44,95% CI: 1.01-5.89, p-value=0.047), history of Premature rupture of membrane (AOR=2.76,95% CI: 1.42-5.38, p-value=0.003), and Mid-upper arm circumference <23cm (AOR=2.79,95% CI: 1.59-4.89, p-value=0.001) were identified as determinants of premature rupture of membrane. Conclusion and recommendation: The identified determinants of premature rupture of membranes were rural residence, multiple gestation, history of Premature rupture of membrane, and Mid-upper arm circumference <23 cm. Therefore, pregnant women who live in rural areas, have multiple pregnancy and had history of premature rupture of membranes should be well followed up during pregnancy. Moreover, early nutritional screening, counseling and intervention should be strengthened during prenatal care.Item MAGNITUDE AND DETERMINANTS OF LOW BIRTH WEIGHT AMONG NEWBORN BABIES IN PUBLIC HOSPITALS OF MEKELLE CITY, TIGRAY REGION, ETHIOPIA, 2024(Mekelle University, 2024-06-28) DESTA FITSUMBackground: Low birth weight is a serious global public health issue which is associated with increased risks of neonatal morbidity, mortality, and later health complications. Low birth weight is present in over 20 million neonates annually, and the vast majority live in low and middle-income countries, particularly in Sub-Saharan Africa. In Ethiopia, the prevalence of Low birth weight is strongly heterogeneous by place, and the prevalence has been between 7.8% and 40%. It has remained a challenge despite global efforts through comprehensive maternal and newborn care. This study addresses the persistent challenge of low birth weight in Ethiopia by identifying context specific risk factors, offering critical evidence to guide targeted interventions and reduce neonatal morbidity and mortality in high burden, resource limited settings. Objective: The objective of this study was to assess the magnitude and determinant factors of low birth weight among newborn babies in public hospitals in Mekelle City, Tigray, Ethiopia, in 2024. Methods: An institutional-based cross-sectional study was conducted. A total sample size of 383 was determined by using Epi Info version 7.2. Participants were selected using systematic random sampling. Data were collected using a semi-structured interviewer-administered questionnaire, that was pre-tested on 5% of the total sample outside the study area to ensure clarity, consistency. The collected data were entered into Epi Info version 7.2, then exported to SPSS version 27 for analysis. Both bivariate and multivariable logistic regression analyses were conducted and variables with a p-value less than 0.2 in the bivariate analysis were entered into the multivariable model. Adjusted odds ratios with 95% confidence intervals were calculated to assess the strength of associations, and statistical significance was determined at a p-value less than 0.05. Ethical clearance was obtained from the Institutional Review Board (IRB) of Mekelle University, and informed consent was secured from all participants. Result: The prevalence of low birth weight is 13.1%. Rural residence (AOR=4.17, 95% CI: 1.19, 14.52), short birth intervals (AOR=5.3, 95% CI: 1.73, 16.17), ANC attendance <4 visits (AOR=5.28, 95% CI: 1.68, 16.53), maternal anemia (AOR=9.31, 95% CI: 2.59, 33.42) and preterm birth (AOR=4.39, 95% CI: 1.38,13.97) significantly associated with LBW. Conclusion and recommendation: Maternal age, rural residence, short birth interval, inadequate ANC follow-up and maternal anemia were significantly associated with low birth weight. Efforts should be made to identify women with high odds of low birth weight.Item DETERMINANTS OF EXTERNALLY VISIBLE BIRTH DEFECTS AMONG NEWBORNS DELIVERED IN PUBLIC GENERAL HOSPITALS OF TIGRAY, ETHIOPIA, 2025 G.C(Mekelle University, 2025-06-28) BIREY YEMARBackground: Birth defects are a series of functional and structural abnormalities resulted from disruption of the normal human embryonic development. Regardless of the interventions and targets to reduce neonatal mortality, the burden of birth defects remains high especially in low and middle income countries such as Ethiopia. In Tigray the neonatal mortality showed significant increment during the war crisis and birth defects takes a significant role with limited studies before the war and no studies conducted after the war. Studies on determinants of birth defects are timely essential to manage their burden and will be a guide on the postwar health care reform. Objective: To asses determinants of externally birth defects among newborns delivered in public general hospitals of Tigray, Ethiopia, 2024/25 Methodology: Institutional based unmatched case control study design was conducted from December 1 to December 30, 2024 among 388 subjects (97 cases and 291controls) in public general hospitals of Tigray. Subjects were selected using systematic random sampling method after proportional allocation to each randomly selected five hospitals. Cases and controls were newborns that had at least one visible minor or major birth defect and without externally visible birth defect, respectively delivered from November 1, 2023-Octeber 30, 2024 in the selected public general hospitals. A structured checklist was used to extract data from maternal medical charts. Data was entered through Epi data and transported to SSPS version 25 for analysis. Multivariate Logistic regression model was used to identify factors associated with birth defects at p value less than 0.05. Results; more than half the mothers (51.5% and 58.4% of cases and controls respectively) fall in between 25 and 35 age category). Rural residence [AOR=1.95; 95% CI:(1.04, 3.667);p-value=0.037], lack of folic acid intake [AOR=2.77;95%CI: (1.464,5.24); pvalue=0.002], history of acute illnesses[AOR=5.118;95%CI:(1.389,18.865);p-value=0.014],male sex [AOR=2.4;95%CI:(1.322,4.364);p-value=0.004],and Prematurity [AOR=11.74; 95%CI :( 2.598, 53.05); p-value=0.001] were significant predictors of birth defects. Conclusion and recommendations; Rural residence, lack of folic acid intake, acute illnesses, newborn sex and prematurity, were significant predictors of birth defects. So that it’s vital to address the modifiable factors such as folic acid intake, acute illnesses, awareness creation and service delivery in rural setting.