Background. Human immunodeficiency virus (HIV) is a major health problem in the world, and failure to implement prevention programs results in an increased number of infections among newborns. The goal of this study was to investigate the evolution and determinants of cluster of differentiation four (CD4) cell count among HIV-infected children who were under antiretroviral therapy (ART). Methods. We follow up a cohort of 201 children aged under fifteen years from October 2013 to March 2017 at Adama Hospital in Ethiopia. To get insight into the data, exploratory data analysis was performed on the change in the longitudinal CD4 cell count. Results. At the baseline, the average number of CD4 cell counts was 468.5 cells/mm3 of blood with a standard deviation of 319.11 cells/mm3. Here, we employed the random intercept and the random slope linear mixed-effects model to analyze the data. Among predictor variables, observation time, baseline age, WHO clinical stage, the history of tuberculosis (TB), and functional status were determinant factors for the mean change in the square root of the CD4 cell count. Conclusions. The finding revealed that the change in the square root of the CD4 cell count increases with an increment of age at diagnosis. Regarding WHO clinical stages of patients, those who were in stage III and stage IV of the HIV/AIDs disease stages relatively had lower CD4 cell counts than stage I patients. This shows the change in the square root of CD4 cell counts of stage III and stage IV patients was 6.43 and 9.28 times lower than stage I patients, respectively. Similarly, we noticed that observation time, the history of TB, and functional status were significantly associated with the mean change in the square root of the CD4 cell count.

Belay Belete Anjullo

Derbachew Asfaw Teni

Linear Mixed Modeling of CD4 Cell Counts of HIV-Infected Children Treated with Antiretroviral Therapy

Background. Second-trimester medical abortion is the termination of pregnancy between 13 and 28 weeks of gestational age. Although the majority of abortions are performed in the first trimester, 10&#x2013;15&#x0025; of terminations of pregnancies have taken place in the second trimester globally. Objective. To identify the determinant factors of second-trimester safe termination of pregnancy in public health facilities of the Amhara region, northwest Ethiopia. Methods. An institution-based unmatched retrospective case-control study conducted from 01/10/2019&#x2013;30/02/2020. A systematic random sampling technique was used to select 119 cases and 238 controls. An interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was fitted to identify determinant factors. The odds ratio with 95&#x0025; CI was computed to assess the strength and significance of the association between dependent and independent variables. Result. Rural resident (adjusted odds ratio (AOR)&#x2009;&#x3d;&#x2009;1.9; 95&#x0025; CI 1.07&#x2013;3.25), irregular menses (AOR&#x2009;&#x3d;&#x2009;1.8; 1.06&#x2013;3.13), had no known symptoms of pregnancy (AOR&#x2009;&#x3d;&#x2009;1.9; (95&#x0025; CI 1.06&#x2013;3.46)), not knowing the abortion law (AOR&#x2009;&#x3d;&#x2009;3.0; (95&#x0025; CI 1.63&#x2013;5.60)), low level of education (1st&#x2013;8th grade) (AOR&#x2009;&#x3d;&#x2009;2.7; (95&#x0025; CI 1.06&#x2013;6.60), opposition against abortion care (AOR&#x2009;&#x3d;&#x2009;2.6; (1.22&#x2013;5.42)), delayed referral (AOR&#x2009;&#x3d;&#x2009;10.1 (95&#x0025; CI 4.02&#x2013;29.18)), and not undertaking pregnancy test (AOR&#x2009;&#x3d;&#x2009;2.2; (95&#x0025; CI (1.21&#x2013;4.04)) were determinants of second-trimester safe termination of pregnancy. Conclusion. Women being rural residents, irregular menses, not undertaking pregnancy test, not knowing the abortion law, low-level educational status, delayed referral, no knowledge about signs and symptoms of pregnancy, and opposition of safe abortion were determinants of second-trimester safe termination. The Regional Health Bureau and Health Facilities should give emphasis to women living in rural areas, and they should increase awareness towards abortion law and sign and symptoms of pregnancy and encourage female education.

Yosef Wasihun

Temesgen Mekonnen

Anemaw Asrat

Samuel Dagne

Yonatan Menber

Netsanet Fentahun

Determinants of Second-Trimester Safe Termination of Pregnancy in Public Health Facilities of Amhara Region, Northwest Ethiopia: An Unmatched Case-Control Study

Background. The health care a woman receives during pregnancy is important for her survival and baby, both at the time of delivery and shortly after that. In the context of high maternal morbidity and mortality in sub-Saharan Africa, fewer than 80&#x0025; of pregnant women receive antenatal care visit services. Receiving antenatal care visits at least four times increases the likelihood of receiving effective maternal health interventions through the antenatal period. This study aimed to identify the utilization and determinants of attending at least four visits in 12 East African countries. Methods. The study used the demographic and health survey data from 12 East African countries from 2008 to 2018. The DHS program adopts standardized methods involving uniform questionnaires, manuals, and field procedures to gather information comparable across countries globally. A multivariable logistic regression model was fitted to identify the determinants of completing at least four antenatal care services. With their 95&#x0025; CI obtained from the adjusted multilevel logistic regression model, the adjusted odds ratio was presented to show the magnitude of the relationship between the independent variable and completing antenatal care visits. Results. The pooled utilization of attending at least four antenatal care visit in the East African region was 52.44&#x0025; (95&#x0025; CI: 52.13, 52.74), with the highest attending at least four or more antenatal care visit visits in Zimbabwe (75.72&#x0025;) and the lowest attending at least four or more antenatal care visit visits in Ethiopia (31.82&#x0025;). The significant determinants of completing at least four ANC visits were age category (24&#x2013;34 (AOR&#x2009;&#x3d;&#x2009;1.24, 95&#x0025; CI: 1.18, 1.31) and 35&#x2013;49 (AOR&#x2009;&#x3d;&#x2009;1.42, 95&#x0025; CI: 1.32, 1.53)); being married women (AOR&#x2009;&#x3d;&#x2009;1.11, 95&#x0025; CI: 1.1.05, 1.16); education levels of primary education (AOR&#x2009;&#x3d;&#x2009;1.20, 95&#x0025; CI: 1.13, 1.27), secondary education (AOR&#x2009;&#x3d;&#x2009;1.24, 95&#x0025; CI: 1.24, 1.47), and higher education (AOR&#x2009;&#x3d;&#x2009;1.91, 95&#x0025; CI: 1.62, 2.14); birth order (2&#x2013;4 (AOR&#x2009;&#x3d;&#x2009;0.75, 95&#x0025; CI: 0.70, 0.79) and 5&#x2b; (AOR&#x2009;&#x3d;&#x2009;0.63, 95&#x0025; CI: 0.58, 0.68)); planned pregnancy (AOR&#x2009;&#x3d;&#x2009;0.81, 95&#x0025; CI: 0.75, 0.86); contraceptive utilization (AOR&#x2009;&#x3d;&#x2009;1.36, 95&#x0025; CI: 1.29, 1.43); wealth status of middle (AOR&#x2009;&#x3d;&#x2009;1.11, 95&#x0025; CI: 1.05, 1.17) and rich (AOR&#x2009;&#x3d;&#x2009;1.25, 95&#x0025; CI: 1.18, 1.32); having no problem accessing health care (AOR&#x2009;&#x3d;&#x2009;1.0.95, 95&#x0025; CI: 0.89, 0.97); and living countries. Conclusions. The coverage of completing the recommended antenatal care visit was low in the region. Age, marital status, mother&#x2019;s and partner&#x2019;s education, women&#x2019;s occupation, birth order, planned pregnancy, contraceptive utilization, wealth status, healthcare accessibility, and living countries were the major determinants of completing recommended antenatal care visits. Therefore, intersectoral collaboration to promote female education and empowerment, improve geographical access to health care, and strengthen implementation of antenatal care policies with active community participation is recommended. In addition, creating a conducive environment in entrepreneurial activities for poor women is needed.

Zemenu Tadesse Tessema

Amare Minyihun

Utilization and Determinants of Antenatal Care Visits in East African Countries: A Multicountry Analysis of Demographic and Health Surveys

About this journal

Advances in Public Health publishes original research articles, review articles, and clinical studies in all areas of public health.

Journal profile

Meet the editorial board

Advances in Public Health maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

Editor spotlight

Find out more

This journal's articles appear in a wide range of abstracting and indexing databases, and are covered by numerous other services that aid discovery and access. Find out more about where and how the content of this journal is available.

Advances in Public Health