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Determinants of Multi-Drug-Resistant Tuberculosis among Tuberculosis Patients in Jimma Zone Southwest Ethiopia, 2025: A Case-Control Study
No full textBackground: Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains the
leading infectious killer globally, with an estimated 10.6 million new cases and 1.25 million
deaths annually. Despite progress in TB control, Multi-drug-resistant tuberculosis (MDR-TB)
remains a major global public health challenge.However; there is limited evidence on the
determinants of MDR-TB in the study area.
Objective: To identify the determinants of multi-drug-resistant tuberculosis (MDR-TB)
among tuberculosis patients in Jimma Zone, Southwest Ethiopia, 2025
Methods: A facility-based unmatched case-control study was conducted among TB patients
attending Shenen Gibe and Limu Genet General Hospitals from March to May, 2025. A total
of 64 cases and 128 controls were selected using a simple random sampling method. Cases
were MDR TB patients, while controls were Drug susceptible TB patients. Data were
collected through a structured questionnaire using Kobo Toolbox and review of clinical
records, then analyzed using SPSS version 27. Bivariable and multivariable binary logistic
regression analyses were performed to identify determinants of MDR-TB. Adjusted odds
ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance
set at p < 0.05.
Results: A total of 192 participants (64 cases and 128 controls) were included in this study
with 100% response rate. Among the participants, 33 (51.6%) of the cases and 57 (44.5%) of
the controls were males. Daily laborers (AOR = 8.50; 95% CI: 3.10–24.38), rural residence
(AOR = 3.93; 95% CI: 1.45–10.63), history of contact with TB patients (AOR = 7.99; 95%
CI: 2.80–22.80), history of drug interruption (AOR = 4.36; 95% CI: 1.41–13.50), history of
previous TB treatment (AOR = 3.20; 95% CI: 1.16–8.89), and being underweight (AOR =
2.66; 95% CI: 1.02–6.90) were found to be determinants of MDR-TB.
Conclusion: MDR-TB was significantly associated with sociodemographic, clinical, and
behavioral factors. Targeted interventions focusing on daily laborers, rural residents, patients
with a history of TB contact or drug interruption, history of previous TB treatment and
underweight individuals are essential to reduce the burden of drug-resistant TB in the region
Effects of Stream Sediment and Water Quality on Macro invertebrate Abundance and Diversity in Gilgel Gibe Watershed, Southwestern Ethiopia F Stream Sediment and Water Quality on Macro Invertebrate Abundance and Diversity in Gilgel Gibe Watershed, Southwestern Ethiopia
No full textBackground: Freshwater ecosystems face intense anthropogenic pressure, threatening water
quality and biodiversity. Benthic macroinvertebrates are key bioindicators of ecosystem health,
yet their response to multiple stressors from water and sediment pollution in tropical watersheds
remains poorly understood. Study on sediment and water quality is helpful for integrated water
resource management. This study investigated the individual and combined effects of stream
sediment and water quality on macroinvertebrate abundance and diversity in the Gilgel Gibe
watershed, Southwestern Ethiopia, in 2024.
Methods: A cross-sectional study was conducted from October to November 2024 across 30
sampling sites in the Gilgel Gibe watershed. Macroinvertebrates were sampled using a
rectangular kicking net (15 × 25 × 40 cm) with a mesh size of 300 m and identified to the family
level with a stereomicroscope and standard guides. Physicochemical water quality parameters
were measured onsite and analyzed in the laboratory using standard methods. Sediment samples
were collected and their physicochemical quality was analyzed. Diversity indices (Shannon
Wiener, Simpson and Margalef) were calculated. Multivariate analysis; Canonical
Correspondence Analysis were applied to examine relationships between sediment and water
quality with macroinvertebrate assemblages. Variance Partitioning Analysis quantified the
relative contributions of water and sediment quality variables to community variation.
Results: A total of 3,370 macroinvertebrates belonging to 7 orders and 36 families were
collected; dominated by Ephemeroptera (34.12%), Trichoptera (27.24%), and Odonata
(13.73%). Collector-gatherers dominated functional feeding groups (26.47%). Principal
Component Analysis explained 37.08% of environmental variation differentiating urban, semi
urban and rural sites. Canonical correspondence Analysis showed Water pH, Water Electrical
Conductivity, Water Turbidity, Water depth, Sediment Electrical Conductivity, Sediment Organic
Carbon and Water width were significant variables which influence the macroinvertebrate
assemblage. Water Electrical Conductivity, Water depth, Biological Oxygen Depth5, Sediment
Electrical Conductivity, Water pH and Sediment Available Phosphorous were the significant
factors which influence the diversity of macroinvertebrates. Variance Partitioning Analysis
revealed shared water and sediment variables explained largest proportion of
macroinvertebrates assemblage variation. Water quality explained more the assemblage
variation than sediment quality.
Conclusion: The study revealed that macroinvertebrate abundance and diversity regulated
jointly by water and sediment quality, and their combined effect is larger than their individual
inputs. The shared effects of water and sediment variables explained a notable portion of
community variation; highlighting the need for integrated ecosystem assessment. Water exerted
a stronger separate influence on the assemblage than sediment quality. Therefore, effective
biomonitoring and conservation of such ecosystems need a concerted approach with a priority
for water quality management within the framework of sediment quality
Assessment of outcome of nosocomial infections and associated factors among pediatric patients admitted at JUMC, Ethiopia
No full textBackground: Nosocomial infections are infections that occur in patients during their hospital
stay and were not present or incubating at the time of admission. Typically, these infections
develop 48 hours after hospital admission and can appear up to seven days after discharge. NI
represent a significant threat to patient safety, often resulting in prolonged hospital stays, long
term health complications, increased resistance to antimicrobial drugs, and a greater risk of
mortality. Furthermore, they contribute to a substantial financial burden on healthcare systems
and impose significant emotional and economic stress on patients and their families. Globally,
hundreds of millions of people every year are affected by NIs, many of which are completely
avoidable. No country or health system, even the most developed or sophisticated, can claim to
be free of NIs.
Objective: To assess the outcome of nosocomial infections and associated factors among
pediatric patients admitted at JUMC, Jimma, Ethiopia
Methods: An institution-based longitudinal study design was conducted on pediatric patients
with nosocomial infections from Nov, 2024 to Nov , 2025.Data were collected by using
structured questionnaire the collected data was entered into Epi Data 3.1 and exported to SPSS
(statistical package for social sciences) version 25.0 for further analysis. Descriptive analysis as
well as bivariate and multi-variable logistic regression analyses was conducted. Statistical
significance was considered at p-values <0.05 and 95% Confidence Interval (CI). Results are
presented as narratives and using tables and figures.
Result: A total of 282 patients diagnosed with NI were included in the study. More than half of
them were male 158(56%), with mean age of 2.1 ± (SD=1.1years ) Most children were admitted
to the General Ward (41.7%) and the Oncology Ward (31.9%), followed by the Neonatal
Intensive Care Unit (NICU) (19.4%).Most common type of Nosocomial infection among
pediatric patient was blood stream infection observed in 208 (73.8%), and followed by
pneumonia in 42(14.95%). A majority of the children (68.2%) had co-morbid diseases and
266(94.3%) were non-reactive for Serostatus.A total of 165 clinical samples were taken for
culture and 40(24.4%) microorganism were identified. About 12(30%) organism were
pseudomonas and CONS 11(27.5%) were isolated and drug sensitivity was observed to
meropenium ,Vancomycin followed by Amikacin.Patients infected with Pseudomonas were
about two times more likely to have an unfavorable outcome compared to those infected with
other organisms(AOR=2.12;CI=1.07-4.02,P=0.032).
Conclusion and recommendation: The overall findings revealed that bloodstream infections
(clinical or bacteriological) were the predominant type of hospital-acquired infection and a
significant number of patients had underlying comorbidity.The most isolated organism are
Gram-negative organisms which is pseudomonas followed by CONS.Most children were
improved and discharged with the poorer out come associated with gram -negative
infections.The high resistance observed to commonly used antibiotics, particularly
cephalosporins, highlights the need for periodic review and updating of empirical treatment
protocol
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
Get PDFThis 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
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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,
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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
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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
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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