Jimma University Open access Institutional Repository
Not a member yet
9497 research outputs found
Sort by
An Investigation Into Efl Teachers’ Perceptions, Practices and Challenges Of Competency-Based Approach To Teach Efl For Academic Purpose; Grade 10 Students Of Limu Genet Town High Schools In Focus.
No full textThe purpose of this study was to Investigate to EFL teachers’ perception, practice and challenges of
competency-based language teaching approach to teach EFL in the high schools for academic purpose of Limu
Genet town high schools grade 10 students in focus. The research designs that was used to carry out the study
was descriptive study designs. A questionnaire, an interview, classroom observation, and Focus Group
discussion were used to collect data. Mixed data analyses that include both quantitative and qualitative
methods were used. The study sites are Limu Genet Town higher secondary schools. The participants of the
study were all EFL teachers in the three high schools 18 EFL teachers and 81 students taken randomly from
three high schools. the total numbers of the participants were 99. Ten item with five Likert-scale questionnaire
prepared for students and 20 item with five Likert-scale questionnaire were prepared for teachers beside this
interview, classroom observation and Focus Group Discussions were used to gather data. The data gained
from the questionnaire were analyzed using the quantitative and the qualitative methods by combining with the
data gained from interview, classroom observation and the transcribed data gained from Focus Group
Discussion. The result showed that EFL teachers have positive perception towards CBLT approach. However,
they were obliged to cover the contents of the materials than the specific competence that would be achieved by
the students. the challenges EFL teachers faced to implement CBLTA in the EFL classroom were; the
principals and supervisors’ focuses on content coverage than competency. The teachers took large class size
as a challenge not as an opportunity. The curriculum itself was not designed to implement CBLT Approach in
the EFL classrooms. The researcher recommend ministry of education should encourage a curriculum designer
to give attention about CBLT approach in high schools, the town education office should encourage EFL
teachers to use CBLT approach in the actual class room in addition to this they should arrange training for
EFL teachers. English department heads and EFL teachers should give priority to the students to use EFL for
day-to-day activity. (To develop students’ competency in using EFL in the 21st century.
Compliance to Antenatal Psychosocial Assessment Practice and the Effectiveness of Antenatal Group-Based Psychoeducation in Preventing Postpartum Depression, Jimma, Ethiopia: A Cluster-Randomized Controlled Trial
No full textBackground: - In Ethiopia, one in five mothers suffers from postpartum depression. It
carries adverse physical and psychological consequences for the mother, child, family, and
society as a whole. Though the condition is an indication of the need for prompt
interventions, there is no assessment and prevention targeted to this problem at maternal
health care units in Ethiopia. Evidence indicates that, to prevent postpartum depression
(PPD), universal screening and psychosocial support to be undertaken in early pregnancy
to be effective. Pertinent to this, the WHO indicates that maternal health care providers
hold a crucial role in detecting, preventing, and, if necessary, providing referrals to mental
health care services.
Objectives: So, the study tried to improve compliance to antenatal psychosocial
assessment practice (ANPA) among maternal health care providers (MHCP) and assessed
the effectiveness of antenatal group-based psychoeducation intervention in preventing PPD
in maternal health care units, Jimma, Ethiopia.
Methods: - To enhance compliance with ANPA practices among MHCP, a pre-post study
design was implemented. Audit, feedback, and re-audit standard criteria were utilized,
alongside a team-based analysis of organizational barriers. Additionally, strategies were
identified to address those barriers. The Joanna Briggs Institute Practical Application of
Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit
and feedback tool were used. The study was conducted from December 2018 to April 2019
using four standard ANPA audit criteria from JBI-PACES for both the baseline and follow
up audits. All MHCP and 66 pregnant women, selected using the consecutive sampling
method, participated. On the basis of the results, the gaps and barriers were analyzed using
GRiP strategies.
The next objective assessed the effectiveness of antenatal group-based psychoeducation
(ANGPE) intervention aimed at preventing PPD while also enhancing postpartum
depression literacy and social support. A cluster-randomized controlled trial was conducted
using a parallel-group, single-blind, and two-arm intervention design with a 1:1 allocation
ratio. This trial took place from March 28 to December 1, 2022, and involved 550
IX
(intervention=286 and control=264) pregnant women across 32 non-adjusted health
centers. The health centers were randomized into two groups, with 16 health centers
assigned to each arm, using a simple randomization technique. The units of randomization
were health centers with an average cluster size of 20 pregnant women, 12-20 weeks of
gestation, who scored (0-9) on the Patient Health Questionnaire-9. The intervention group
received usual care plus five ANGPE classes, while the control group received only usual
care. A well-validated patient health questioner-9, functional social support, and PPD
literacy scale assessed PPD, social support, and PPD literacy, respectively. Data were
collected in face-to-face interviews at 12–20 weeks gestation and 6 weeks postpartum. An
Intention-to-treat analysis was used, and baseline characteristics were compared between
groups using a χ² and an independent sample t-test for categorical and continuous
measures, respectively. Finally, the magnitude of the intervention effect and predictors of
the outcome variable were analyzed by using a relative risk and a mixed-effect model
based on the objective of the study.
Result: The baseline audit result revealed a 0% compliance rate for all evidence-based
ANPA audit criteria. Lack of knowledge or training gaps, weak internal referral system or
weak linkage between antenatal clinic and medical or behavioral treatment services, lack
of locally validated tools for assessing depression in the antenatal clinic, client load, and
shortage of private rooms were identified as barriers. However, the post implementation
result showed that an average 91.5% practice of evidence based ANPA was applied as per
standards by working on the above identified barriers.
Regarding the cluster randomized controlled trial: - The overall response rate at the end
line was 92.9%. The results showed that the prevalence of (PPD) in the intervention
clusters was significantly lower than in the control group, with rates of 20 (7%) compared
to 74 (28%), P = 0.001. Additionally, the relative risk (RR: 0.25 [0.07/0.28]) indicates that
mothers who received ANGPE were 75% less likely to develop PPD than those in the
control group who received only the usual care. Additionally, after controlling the
community and individual-level variables, a mixed-effect analysis showed that ANGPE
intervention (65%; AOR = 0.35, 95% CI = 0.13–0.99), social support (AOR = 0.04, 95%
X
CI = 0.01–0.15), partner emotional support (AOR = 0.24, 95% CI = 0.12–0.51), PPD
literacy (AOR = 0.25, 95% CI = 0.11–0.62), and self-esteem (AOR = 0.22, 95% CI =
0.11–0.47) were more likely to protect mothers from PPD. On the contrary, domestic work
(AOR = 9.75, 95% CI = 3.37–28.16), neonates with complications (AOR = 5.79, 95% CI =
2.04–16.45), and unhealthy coping (AOR = 2.39, 95% CI = 1.06–5.42) exposed mothers to
PPD.
Furthermore, the study showed that mothers in the intervention arms were 2.04 times more
likely than controls to have adequate social support (RR=2.044, 95% CI: 1.684-2.481).
Similarly, mixed-effect analysis indicated that mothers in the intervention clusters (3.607;
AOR=2.136–6.090) had partner emotional support (AOR=1.61; 1.00–2.59) and get support
from their mother (AOR=4.25; 1.78–10.15) had adequate social support. However,
mothers with PPD (AOR=.057 (.02-.19)), unhealthy coping (AOR=.27), and loneliness
(AOR=.28 (.11-.69)) were less likely to have adequate social support.
Furthermore, the study demonstrated a significant difference between groups regarding the
overall mean PPD literacy score (intervention, 3.75±.46; control, 3.48±.46; ηp²=.07),
ability to recognize PPD (intervention, 4.30±.64; control, 3.94±.75; ηp²=.06), knowledge
of risk factors and causes (intervention, 4.03±.69; control, 3.67±.70; ηp²=.05), and access
to PPD information (intervention, 3.28±1.25; control, 2.01±1.13; ηp²=.21) at p=.001, with
marginal significance regarding self-care activities (intervention 4.37±.54, control
4.26±.50, ηp²=.01, P =.051). Conversely, there were no significant differences in
knowledge of professional help (intervention 2.97±1.13, control 2.83±.80, ·p²=.00,
P=.303), beliefs regarding professional help (intervention 2.67±.89, control 2.50±.72,
·p²=.01, P=.063), and attitudes towards PPD recognition and help-seeking (intervention
3.91±1.02, control 3.91±1.02, ·p²=.00, P=.586). Moreover, partner emotional support
(AOR = .1, 95% CI = .02–.17), unhealthy coping (AOR = -.14, 95% CI = -.22–(-.07)), and
multiparty (AOR = -.15, 95% CI = -.22–(-.08)) showed significant associations with
overall PPD literacy score
Prevalence of bacterial vaginosis and assessment of Associated factors among pregnant women attending the Antenatal care clinic of jimma medical center, southwest Ethiopia
No full textBackground: Bacterial vaginosis (BV) is a common vaginal dysbiosis characterized by a
reduction in protective Lactobacillus species and an overgrowth of diverse facultative and
anaerobic bacteria such as G. vaginalis. BV is a significant public health concern, particularly
among pregnant women, as it is associated with adverse obstetric outcomes such as preterm
birth and increased susceptibility to STIs. The epidemiology and contributing factors of BV
demonstrate geographical variability, with higher prevalence rates reported in sub-Saharan
Africa. Despite its prevalence, limited data exist on BV and its associated factors among
pregnant women in southwest Ethiopia.
Objective: The purpose of this study was to determine the prevalence of bacterial vaginosis
and assess associated factors among pregnant women attending the antenatal care clinic of
Jimma Medical Center from January 1 to March 30, 2025, Jimma town, Southwest Ethiopia.
Methods: A cross-sectional study was conducted at Jimma Medical Center from January to
March 2025, involving 285 pregnant women attending antenatal care. Systematic random
sampling was used to recruit participants. Data were collected through structured interviews
and laboratory analysis of vaginal swabs. Diagnosis of BV was based on Amsel‘s clinical
criteria and Nugent scoring from Gram-stained smears. Culture technique was used to
explore microbiological profile. Data were entered into EpiData 3.1 and analyzed using SPSS
version 25. Descriptive statistics were used to summarize the data, and Multivariate logistic
regression analysis was conducted to identify variables independently associated with BV. P
value <0.05 was considered statistically significant.
Results: The overall prevalence of BV was 22.5% (64 out of 285). Significant independent
predictors of BV included: history of STIs (AOR=6.279, CI: 1.844, 21.381), vaginal
discharge (AOR=3.143, CI: 1.106, 8.937), lower abdominal pain (AOR=4.055, CI: 1.372,
11.985), spontaneous abortion (AOR = 7.995, CI: 2.139, 29.882), preterm labor or birth
(AOR=10.043, CI: 3.009, 33.522), vaginal douching (AOR=5.6, CI: 2.01, 15.5), and having
multiple sexual partners (AOR=8.468, CI: 2.390, 30.008). G. vaginalis was the most
frequently isolated organism.
Conclusion: Bacterial vaginosis is common among pregnant women in this setting and is
significantly associated with clinical symptoms and behavioral factors. Its link to adverse
pregnancy outcomes emphasizes the need for early detection and management.
Recommendation: Routine screening for BV should be integrated into antenatal care
services, particularly for women with a history of STIs or obstetric complications. Health
education programs should address harmful vaginal hygiene practices and promote safe
sexual behaviors. Further longitudinal studies are recommended to explore causality and
evaluate treatment outcomes
Factors affecting the use of market information by wheat Farmers and its impact on their income: the case of omo beyam District, jimma zone, and southwest ethiopia
No full textThis study investigates factors affecting the use of market information by wheat farmers and
its impact on their income in Omo Beyam district, Jimma Zone, and Southwest Ethiopia.
Two-stage sampling procedures was chosen to select district and kebeles based on the high
potential of wheat production and the participation of producers in wheat marketing. The
study used data on 245 respondents collected through a structured questionnaire from Omo
Beyam district, Jimma Zone. Descriptive and Propensity score-matching inferential methods
were employed to analyze the data. Findings show that 59.19% of respondents use market
information, with family size as a significant determinant; larger households are more likely
to use market information. Proximity to markets also facilitates better access to timely
information, while education level significantly correlates with use rates, as literate farmers
outperform their illiterate counterparts
Population status and Sleeping Site Preferences of Olive Baboons (Papio anubis) in Setema District, Jimma Zone: Implications for Human-Baboon Conflict Management
No full textOlive baboons (Papio anubis) were in the Class Mammalia and belong to the Order Primates
alongside with man. They are one of the four savannah baboons found in different part of
Africa. The objective of this study was to assess the population status, sleeping site selection
of Olive baboon as well as their conflict with humans in Setema district Jimma zone, Oromia
Regional state South Western Ethiopia. To estimate the population status of Olive baboon,
direct total count method was used during wet and dry season. Population counting was
conducted early in the morning at 6:00 to 9:00 am and late afternoon at 5:00 to 6:00 pm. For
olive baboon sleeping site selection, in addition to information from the local community,
trailing and tracing system method was used. Human-wildlife conflict data were-collected
using questionnaires, key informants, and focus group discussions (FGDs)
ASSESSMENT of ROAD ASSET MANAGEMENT PRACTICES AND ITS CHALLENGES: A CASE of ETHIOPIAN ROADS ADMINISTRATION
Full text linkThis research explores the Assessment of Road Asset Management Practices and Challenges
within the Ethiopian Roads Administration (ERA). Roads are pivotal to Ethiopia's socio
economic growth, connecting remote areas and enabling the movement of goods and people.
Despite significant improvements in road density and network expansion since the inception of
the Road Sector Development Program (RSDP) in 1997, challenges persist in asset management
practice, maintenance, and sustainability.
The study utilized both qualitative and quantitative approaches, incorporating questionnaire
surveys, interviews, and desk reviews, aimed at professionals engaged in road asset management
of ERA. The study findings reveals that, ERA's approach to road asset management practices
integrates methods and approaches such as own-force Road maintenance contractor, private
contractor engagements, axle load control systems, and periodic traffic surveys. These methods
and approaches collectively aim to ensure the sustainability and efficiency in Road asset
management practices of ERA for the road network. Although some modern technological tools
such as automated data collection systems for Road condition assessment and axle load control
have been introduced in ERA’s Road asset management practices, their integration remains
limited. The study findngs also highlighted that significant challenges including financial
constraints, gaps in technological adoption in Road asset management, limited technical and
resource capacity of ownforce road maintenance contractor, and inadequate stakeholder
engagement, Road asset management components challenges and weak regulatory enforcement
(absence of Road policy), which collectively undermine the effectiveness of ERA’s Road asset
management practices.
Finally it’s recommended that ERA shall works on adoption of centralized data management
systems, enhanced use of automated technologies in road asset management practice, enhanced
funding mechanisms and structured capacity-building initiatives for ownforce road maintenance
contractor and professional works on road asset management. Improving these areas will enable
ERA to optimize resource allocation, sustain road assets, and contribute significantly to
country's economic progress
Trends, Determinants, and Perinatal Outcomes of Uterine Rupture: The Role of Three Delays at Nekemte Specialized Hospital, West Oromia, Ethiopia
No full textUterine rupture is a life-threatening obstetric emergency characterized by the complete disruption
of the uterine wall, including the endometrium, myometrium, and serosa. This condition poses
significant risks to maternal and neonatal health, such as severe hemorrhage, infection, and
perinatal death. The prevalence of uterine rupture is markedly higher in low- and middle-income
countries due to limited access to quality maternal healthcare. In Ethiopia, facility-based studies
indicate a prevalence of 1% to 5% in specialized hospitals, with uterine rupture contributing
significantly to maternal mortality (10%-25%) and perinatal mortality rates exceeding 50%.
Recognizing this public health concern, the study was conducted to understand the prevalence,
determinants, and outcomes of uterine rupture at Nekemte Specialized Hospital, Oromia, Ethiopia,
and to provide evidence for localized healthcare interventions.
Methods
A mixed-methods design was employed for this study. Quantitative data were collected
retrospectively from hospital records spanning 2014 to 2022, analyzing trends, prevalence, and
associated factors. Regression modeling was used to identify predictors of maternal and neonatal
outcomes. Qualitative data were gathered through phenomenological interviews with twelve
uterine rupture survivors and four key informants, exploring emotional, physical, and social
impacts. Systematic random sampling was applied for the quantitative component, while
purposeful sampling was used for the qualitative interviews. Quantitative data were analyzed using
SPSS software, and qualitative data were thematically analyzed.
Results
The study revealed several significant findings. Over nine years, there was a gradual decline in
uterine rupture prevalence, reflecting improvements in maternal healthcare services. Key
determinants of uterine rupture included lack of antenatal care, high parity, rural residency,
previous cesarean sections, and prolonged labor. Maternal outcomes highlighted high mortality
rates caused by hemorrhage, uterine atony, and infections, with survivors often experiencing long-
term complications such as anemia and infertility. Neonatal outcomes were equally severe, with
xiii
perinatal mortality exceeding 50%, primarily due to birth asphyxia and stillbirth. Premature
delivery and low birth weight were identified as significant predictors of neonatal mortality.
The study also examined the impact of the three-delay model. Cultural beliefs, financial barriers,
and a lack of awareness influenced delays in seeking care. Delays in reaching care stemmed from
geographical barriers, poor road infrastructure, and transportation challenges. Finally, delays in
receiving adequate care were linked to shortages of trained healthcare personnel, inadequate
emergency obstetric services, and inefficient referral systems.
Women who survived uterine rupture shared their lived experiences, which included profound
psychological, social, and economic challenges. Survivors reported experiencing post-traumatic
stress disorder, anxiety, and depression. Cultural stigmatization and feelings of guilt exacerbated
their psychological distress. Socially, survivors often faced marital discord, community
ostracization, and financial hardships caused by medical expenses and loss of productivity. Despite
these challenges, coping mechanisms such as family support, healthcare providers' assistance, and
community organization engagement were instrumental in recovery. However, access to
counseling and rehabilitation services was limited.
Conclusions
Uterine rupture remains a significant public health challenge in Ethiopia, particularly in resource-
constrained settings. To address this, healthcare infrastructure should be improved through
investments in emergency obstetric services, including training, deploying skilled birth attendants,
and providing essential medical supplies. Strengthening referral systems by enhancing
communication and transportation networks is also critical to reducing delays in accessing care.
Community education campaigns are needed to raise awareness about the importance of early
healthcare-seeking behavior and to address cultural stigmas surrounding maternal health.
Additionally, psychosocial support programs, including counseling and rehabilitation services,
should be established to address survivors' needs. Finally, region-specific policies must be
developed to tackle disparities in maternal healthcare access and outcomes
Seroprevalence of hepatitis b, status liver and Associated factors among prisoners at Arbaminch town south ethiopia regional state Ethiopia
No full textBackground: Hepatitis B is the world's most common serious liver infection. It is caused by the
hepatitis B virus that attacks and injures the liver. Each year, up to 1 million people die from
hepatitis B, even though it is preventable and treatable. WHO global hepatitis strategy, endorsed
by all WHO Member States, aims to reduce new hepatitis infections by 90% and deaths by 65%
between 2016 and 2030 among high-risk groups like prisoners, commercial sex workers, and
homosexual behaviors.
Objective: This study aimed to determine the seroprevalence of hepatitis B, assess liver status
using liver enzyme tests and APRI scores, and identify associated factors among prisoners at Arba
Minch town, South Ethiopia, from February to April 2024.
Methods: A cross-sectional institution-based study was conducted on prisoners at Arba-Minch
town from February 1 to April 2024. Sociodemographic, medical, and institution-related data
were collected using a mobile data collection tool, Kobo Toolbox, and the data were imported into
STATA version 17 for further analysis. Venous blood was collected from participants and analyzed
for HBsAg, complete blood count, and liver enzymes. Univariate and multivariate logistic
regression analysis assessed the association between the independent and outcome variables. The
strength of association from the logistic regression was assessed using odds ratios (ORs) with a
95% confidence interval (CI), and statistical significance was set at p-value <0.05.
Result: A total of 922 inmates participated in the study, of whom 849 (92.08%) were male and 73
(7.92%) were female. The mean age was 31.9 years (±10.74SD), and the median age was 29 years
(IQR 24-37). The overall seroprevalence of HBsAg was 2.82%. The majority of hepatitis B-positive
participants were male, and ALT and AST can show elevation. Body piercing (AOR: 2.90, 95%
CI: 1.13-7.43, p=0.026) and having multiple sexual partners (AOR: 12.56, 95% CI: 4.57-34.50,
p=0.001 were significantly associated with HBsAg. About 27% of individuals suggested they
would be eligible for antiviral medication according to standard clinical guideline.
Recommendation: recommended that the government should start HBV vaccination campaigns,
begin with mass vaccination, and implement a national immunization program and Arba-minch
town prison can screen prison when before mixing with previous prisoners and separate prisoners
to limit contact with each other in rooms and health education must give for those prisoners about
hepatitis B virus transmission
Conclusion Body piercing and having multiple sexual partners were significant factors associated
with the hepatitis B virus infection. Abnormal elevation of ALT and AST levels show elevation and
one-third of the study population who tested positive for HBsAg were eligible for anti-viral
treatment based on APRI score
ASSESSMENT OF CONDITIONS OF CONTRACT CLAUSES USED IN STATE OWNED CONSTRUCTION PROJECTS A CASE OF JIMMA
No full textDue to its forward and backward links with other sectors, the construction industry contributes significantly to the economy of any nation by creating jobs and wealth. Unfortunately, a lot of projects in developing nations suffered from incredibly significant cost overruns, delays in completion, and poor quality. Among other things, one of the contributing elements in the construction industry is problems with contract terms. Consequently, the quality required to achieve its criteria is lacking in domestic contract administration and construction management processes. In this regard, the purpose of this study is to identify gaps in the local construction contract conditions in Ethiopia and to identify clauses that have had an adverse effect on the sector's development.
The data collection method integrated questionnaire survey, interview and desk study. Samples for the study have been randomly selected from a clustered group of public employers, domestic consultants, and domestic contractors who are actively participating on construction works. In this thesis, a descriptive and inferential statistical analysis method has been used. Interpretation and discussions were made based on results from the analysis.
As a result, the price adjustment clauses are not sufficient to compensate the current soaring prices. Besides, termination is not exercised as per the contract provisions whereas claim substantiation and dispute resolution lack a balance of risk favoring the employer in most cases. In addition, another finding reveal that the civil procedure code Art. 315(2) hinders arbitration practices for administrative contracts. Some concepts such as experienced contractor need to be expressed in a more clear and concise manner to reduce subjectivity. Furthermore, local contract forms lack suitability to manage construction projects efficiently.
Finally, the study concludes that the performance of the local construction industry, construction management, and contract administration procedures fall short of the criteria set by contract rules. This study further provides recommendations on how to improve the existing prevailing situations of the local construction sector in general and construction management practices in particular
Implication of Cholera Exposure on Incidence, Time to Recovery, and Continuum of Care for Severe Acute Malnutrition among Children in Ethiopia: A Mixed Methods Study
No full textThis research highlights the relationship between infection and malnutrition, specifically
examining how cholera exposure contributes to the development of severe acute malnutrition
(SAM) in children under fifteen years. It reveals how cholera impacts both the incidence and
recovery of SAM, emphasizing the need for continuous nutritional healthcare during outbreaks to
prevent severe acute malnutrition. Addressing a gap in previous studies, this research project
includes older children, providing a more comprehensive view of SAM. Key determinants such as
cholera exposure, inadequate meal frequency and diversity, poor sanitation, economic hardship,
and limited healthcare access are analyzed to show how these factors intensify cholera’s effect on
malnutrition. Findings underscore the importance of integrated health strategies that address
infections and malnutrition. This dissertation offers evidence-based insights for developing
targeted interventions, especially in Ethiopia, to reduce SAM incidence, improve the continuum
of nutritional care during and after emergencies, and accelerate recovery among cholera-exposed
children. Here are the summarized details.
The first chapter of this dissertation serves as a comprehensive introduction to acute malnutrition
and the burden of Cholera, emphasizing their interconnection. It begins by defining cholera and
SAM, exploring common drivers and consequences of both conditions. The chapter presents an
overview of cholera and SAM's global, regional, and national status, highlighting their prevalence
and public health impacts. It further addresses the determinants contributing to SAM, providing
insights into socio-economic, nutritional, and health-related factors. Additionally, the chapter
outlines strategies and approaches implemented to mitigate the burden of malnutrition and promote
healthier outcomes while also identifying gaps and areas that previous studies may have
overlooked regarding the interaction between SAM and cholera.
The second chapter outlines the general methods employed in this study. It provides an overview
of the study design, period, setting, and population. In addition, the chapter describes the inclusion
and exclusion criteria used to select participants, the sampling strategy, and the sample size
calculations to ensure statistical power. Furthermore, it elaborates on the data collection methods
and procedures, the specific tools or instruments used to collect data, data management procedures,
1
including data entry, storage, and quality control measures, information on statistical tests,
software packages, or analytical techniques employed to examine the study variables and assess
the outcomes of interest. Additionally, it covers the study variables of interest, explaining the key
measures or indicators used to assess the outcomes under investigation. Ethical considerations are
emphasized in this chapter, highlighting the steps taken to ensure the protection of participants'
rights and well-being.
In the third chapter, the systematic review of the global magnitude of SAM among children with
cholera is presented. This systematic review and meta-analysis focused on children under fifteen,
utilizing a comprehensive search of databases including PubMed, Scopus, CINAHL, and Cochrane
Library. Two independent reviewers performed full-text evaluations and critical appraisals using
the JBI tool, resolving disagreements through discussion. From an initial 8,731 articles published
between 1912 and 2023, 38 were reviewed, leading to the inclusion of six studies. The findings
indicated that acute malnutrition among children with cholera ranged from 8% to 41%, with a
pooled SAM prevalence of 21.18% and no significant heterogeneity among studies. While all
studies focused on children under five, only one examined those under nine, highlighting a
research gap for older children. The review identified the absence of malnutrition screening for
children aged five to fourteen, and underscored driving factors of malnutrition, including diarrheal
diseases, poor sanitation, inadequate feeding practices, and low family income, alongside unsafe
water and poor hygiene exacerbating cholera spread. The findings underline the need for updated
treatment guidelines and comprehensive food and nutrition policies to effectively prevent
malnutrition and improve health outcomes for vulnerable children, especially those affected by
cholera.
In the fourth chapter, the qualitative study on mothers’ experiences within the continuum of care
for children suffering from acute malnutrition and cholera is presented. Using a phenomenological
approach, the study engaged ten participants to explore their lived experiences. Findings indicate
that factors such as poverty, poor feeding practices, supply interruptions, and the exclusion of
children aged five and older from malnutrition screenings significantly hinder early detection and
treatment of malnutrition. Additionally, mothers and caregivers reported that a lack of support for
2
them from health facilities during their stay at the health facility for their children's treatment often
forced them to discontinue SAM care, with complications. This lapse adversely affects the
continuum of care and exacerbates malnutrition prevention and treatment efforts. To address these
critical gaps, the study recommends strengthening emergency nutrition programs within the
healthcare system and revising food and nutrition policy to better incorporate emergency nutrition
strategies, with a strong emphasis on all children under fifteen years old.
In chapter five, the incidence of SAM among children exposed and unexposed to cholera,
involving 550 participants, is presented. The overall incidence of SAM was found to be 40.7%,
with 25.8% in the cholera-unexposed group and 55.6% in the cholera-exposed group. Key findings
indicate that cholera-exposed children had 1.56 times higher probability of risk [Adjusted Hazard
Ratio (AHR): 1.56, CI: 1.15-2.12] to develop SAM compared to their unexposed counterparts.
Additionally, children under five years old had 1.67 times higher probability of risk [AHR: 1.67,
95% CI: 1.24-2.25] to experience SAM than those aged five to fourteen. The study also revealed
that children whose parents lacked nutritional knowledge had 1.65 times higher probability of risk
[AHR: 1.65, 95% CI: 1.25-2.18] to suffer from SAM than those whose parents were well
informed. Furthermore, children with poor dietary diversity practices had almost twice high
probability of risk [AHR: 1.83, 95% CI: 1.23-2.70] to develop SAM compared to those with good
practices. The risk of SAM was more than doubled [AHR: 2.33, 95% CI: 1.52-3.56] among
children who did not complete oral cholera vaccination (OCV) compared to those who did.
Additionally, children from households that did not treat water safely had 1.61 times higher
probability [AHR: 1.61, 95% CI: 1.21-2.14] to be at risk of SAM. The study identifies several
determinants that significantly increase the risk of SAM, including cholera exposure, inadequate
dietary diversity, younger age, inadequate water treatment practices, insufficient parental
nutritional knowledge, and incomplete cholera vaccination. Collaborative efforts among
policymakers, partners, and healthcare providers are essential to address these challenges.
Strategies should focus on enhancing nutritional education for parents, improving dietary diversity,
ensuring access to clean water, and increasing vaccination coverage. By fostering collaboration
and implementing targeted interventions, the incidence of SAM in children can be effectively
3
reduced, ultimately improving health outcomes and resilience in vulnerable children affected by
cholera.
Chapter Six addresses the recovery time from SAM and its determinants among children exposed
and unexposed to cholera. This study utilized a prospective cohort design, tracking the time to
recovery for 224 children with SAM. The findings revealed that nearly 80% of participants
recovered, with a recovery rate of 40 per 1,000 person-week observations and a median recovery
time of 21 days [Inter Quartile Range: 14-28 days]. Key determinants influencing recovery
included food insecurity, meal frequency, and parental attitudes toward children's dietary habits.
Specifically, children from food-insecure families had a 39% lower probability of achieving rapid
recovery than those from food-secure households. Children who consumed three or more meals
daily had a 1.61 times higher probability of a faster rate of recovery than those who ate less
frequently. Moreover, children from families with positive attitudes towards nutrition had a 2.23
times lower probability of rapid recovery from acute malnutrition. The study also identified
cholera exposure as a significant factor, with cholera-exposed children having a 54% lower rate of
recovery from SAM than their unexposed counterparts. To improve recovery times and outcomes
for children suffering from SAM, especially in the context of cholera exposure, the study
recommends developing interventions that address food insecurity, meal frequency, and nutritional
attitudes.
Chapter seven presents the general discussion and implications of the findings for children
affected with cholera, conclusions, and recommendations for further research