ABSTRACT Background Despite significant advancements in antiretroviral therapy (ART), loss to follow‐up (LTFU) remains a critical challenge in HIV care, particularly in low‐resource settings like Ethiopia. LTFU contributes to increased morbidity and mortality rates, heightened transmission risks, and treatment failure. While individual and clinical factors have been widely studied, structural drivers of LTFU are less understood. Hence, this study aimed to understand the structural factors driving LTFU in HIV care. Methods A qualitative study using grounded theory was conducted. Data were collected through Key Informant Interviews (KIIs) with program staff, Focus Group Discussions (FGDs) with social support groups, and group interviews with program coordinators and regional directors. Thematic analysis was performed using ATLAS. ti. Software version 7.5.18, and findings were reported following the Standards for Reporting Qualitative Research (SRQR). Results Four key themes emerged from the analysis: (1) programmatic and service challenges, including drug supply interruptions, inadequate service integration, and human resource shortages; (2) weak transfer, linkage, and tracing systems, marked by gaps in referral networks and untraceable client identifiers; (3) cultural and socio‐behavioral factors, such as stigma, discrimination, and reliance on faith‐based healing practices. Participant quotations highlighted the pervasive impact of stigma and weak referral systems on patient disengagement from HIV care; and (4) integration gaps in social change and stakeholder engagement, including weak counseling services and limited collaboration with non‐governmental organizations and community organizations. Conclusion The findings underscore the critical role of structural factors in shaping retention in HIV care in Oromia. Addressing these barriers may benefit from a multi‐faceted approach, including strengthening health systems, improving referral and tracing mechanisms, reducing stigma, and enhancing stakeholder engagement. These insights provide a foundation for targeted interventions to reduce LTFU and improve HIV care outcomes in the region.
ABSTRACT Background and Aims Evidence on the association between common mental disorder symptoms and adolescent smoking in a large nationally representative sample remains limited. We investigated this relationship among Indonesian adolescents using national survey data. Methods We analysed cross‐sectional data from the 2018 Indonesian Basic Health Research survey, a two‐stage stratified sample of 176,555 adolescents aged 10–18 years. Symptoms of common mental disorder were assessed in 70,969 adolescents aged 15–18 years using the Mini International Neuropsychiatric Interview (MINI) questionnaire and the Self‐Reporting Questionnaire‐20. We estimated the prevalence of adolescent smoking. We developed a directed acyclic graph (DAG) to identify the potential confounders and applied multivariable logistic regression models with survey weights to evaluate the association between common mental disorder symptoms and adolescent current smoking, controlling for measured confounders. Results The prevalence of adolescent current smoking aged 10–18 years in Indonesia was 9.10% (95% CI: 9.03, 9.16). The prevalence of adolescent current smoking among those completing common mental disorder symptom assessment was 18.14% (95% CI: 18.00, 18.18). Both cohorts showed higher prevalence in male, older, and rural groups. Adolescents with symptoms of common mental disorder had increased odds of current smoking: estimated odds ratio of 1.59 (95% CI: 1.40, 1.81). Important measured confounders of the estimation obtained from DAG analysis and adjusted for in the final model were age, sex, current education, place of residence, working status, and health behaviours (alcohol use, physical activity, and dietary patterns). Conclusions The prevalence of adolescent smokers in Indonesia is higher than reported previously. This study established the association between common mental disorder symptoms and adolescent current smoking. Incorporating mental disorder screening and support into prevention strategies could strengthen interventions and inform future policy to reduce the increased prevalence of youth smoking.
ABSTRACT Background Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) remain major public health challenges globally and in Ethiopia. Although policies, regulations, and strategies have been developed to support their control and elimination, translating these policy commitments into effective implementation remains challenging. Understanding stakeholder experiences and perspectives is important for identifying gaps in policy awareness, participation, implementation, and program coordination. Objective This study aimed to explore the challenges and opportunities affecting the development, implementation, and effectiveness of HIV, HBV, and HCV control and elimination policies, regulations, and strategies in Ethiopia. Methods A facility‐ and institution‐based qualitative study was conducted among stakeholders involved in HIV, HBV, and HCV policy development, implementation, regulation, monitoring, research, and service delivery. Thirty‐four participants were purposively selected based on their professional roles, experience, knowledge, and involvement in relevant programs. Data were collected from April 17 to May 27, 2023, using qualitative interviews and focus group discussions, complemented by a review of relevant policy, strategy, guideline, and program documents and observations of selected service‐delivery and pharmaceutical settings. Data were transcribed, translated where necessary, and thematically analysed using MAXQDA Analytics Pro 2024. The analysis focused on policy awareness, stakeholder involvement, stakeholder roles, implementation status, opportunities, and challenges. Results Participants had a mean work experience of 16.82 years (SD = 0.79), and 30 (88.2%) were male. Of the 34 participants, 12 (35.3%) clearly identified or described the existence and key features of HIV, HBV, and HCV control and elimination policies, regulations, and strategies, while 22 (64.7%) did not. Fifteen (44.1%) participants reported stakeholder involvement in policy and strategy development, whereas 19 (55.9%) did not report adequate opportunities for participation. Most participants, 32 (94.1%), demonstrated an understanding of stakeholder roles and responsibilities in policy development and implementation. However, only 8 (23.5%) participants reported a clear current implementation status or progress, while 26 (76.5%) reported no clear implementation status. Twenty‐nine (85.3%) participants reported limited or unclear opportunities for strengthening HIV, HBV, and HCV control and elimination. Nearly all participants, 32 (94.1%), identified challenges affecting policy and strategy implementation, including COVID‐19‐related disruptions and concerns regarding the translation of policies and strategies into practice. Conclusion The findings indicate a substantial gap between recognition of stakeholder responsibilities and the practical awareness and implementation of HIV, HBV, and HCV control and elimination policies, regulations, and strategies in Ethiopia. Strengthening policy dissemination, inclusive stakeholder engagement, implementation monitoring, coordination, and the translation of policy commitments into service‐delivery activities may support progress toward national and global elimination targets. Sustainable financing, strengthened health‐system capacity, stakeholder accountability, and reliable monitoring and evaluation systems are important considerations for improving implementation.
ABSTRACT Background Traditional uvulectomy remains a significant public health concern in Ethiopia. Despite multiple complications associated with this traditional malpractice like bleeding and infection transmission the practice continues. This traditional practice is more commonly performed on infants. This study provides evidence on the prevalence and associated factors of traditional uvulectomy. Objective The aim of this study was to assess the prevalence of and associated factors for traditional uvulectomy among infants under 12 months of age who visited the University of Gondar Comprehensive Specialized Hospital, 2024/2025. Method A hospital‐based cross‐sectional study was conducted among infants under 12 months of age who visited the University of Gondar Comprehensive Specialized Hospital from August 2024 to January 2025. A pretested, researcher‐administered questionnaire was used to interview caregivers and extract data from medical records. The data were collected using the Kobo Toolbox by two trained general practitioners and analyzed using STATA version 17 software. Binary and multivariable logistic regressions were employed to determine factors associated with traditional uvulectomy and the presence of multicollinearity was checked and no value more than 3 was there. The statistical association between dependent and independent variables was declared at p‐value of ≤ 0.05. Results A total of 426 participants were included in this study, with ages ranging from 3 days to 12 months and a median age of 3 months (interquartile range [IQR] = 0.9–9 months). The prevalence of traditional uvulectomy was 69.7%. Among the participants, poor maternal knowledge and poor attitude were prevalent, accounting for 69.3% and 65.3%, respectively. Identified factors for traditional uvulectomy were: mothers with no postnatal counseling (adjusted odds ratio [AOR] = 3.08, 95% confidence interval [CI]: 1.65–5.73), mothers with poor attitude (AOR = 4.41, 95% CI: 1.87–8.96), and mothers with poor knowledge (AOR = 8.30, 95% CI: 3.70–18.61) toward traditional uvulectomy. The model had good performance, with a Hosmer‐Lemeshow goodness‐of‐fit test p‐value of 0.236. Conclusion The prevalence of traditional uvulectomy was high. Lack of postnatal counseling about traditional uvulectomy, poor attitude, and poor knowledge were found to be independent contributing factors for traditional uvulectomy. Practicing comprehensive and consistent parental and postnatal health education and counseling about traditional uvulectomy is very important to overcome this malpractice.
ABSTRACT Background and Aim Multiple sclerosis (MS) is a chronic neurological disease that can affect patients’ health‐promoting lifestyle and psychological well‐being and may also place substantial demands on family caregivers. This study aimed to evaluate the effect of a family‐centered empowerment intervention based on the Family‐Centered Empowerment Model (FCEM) on health‐promoting lifestyle and psychological well‐being among patients with MS, with the active involvement of their primary family caregivers. Methods This randomized controlled clinical trial was conducted from February to April 2025 at an MS clinic in Fars Province, southern Iran. It included 70 patient‐caregiver dyads, comprising 70 patients with MS and their primary family caregivers. The dyads were randomly assigned to the intervention or control group, with 35 dyads in each group. Patients and caregivers in the intervention group took part in a structured family‐centered empowerment program based on the four‐stage FCEM. The program consisted of five to seven face‐to‐face educational sessions attended jointly by the patients and their primary family caregivers. The control group continued to receive routine care. Health‐promoting lifestyle and psychological well‐being were assessed at baseline, immediately after the intervention, and at the 2‐month follow‐up. Results At baseline, the two groups did not differ significantly in health‐promoting lifestyle or psychological well‐being (p > 0.05). Following the intervention, the mean health‐promoting lifestyle score was 126.40 ± 25.18 in the intervention group and 102.62 ± 25.18 in the control group (p < 0.001). At the 2‐month follow‐up, the corresponding scores were 124.34 ± 22.39 and 104.22 ± 20.23, respectively (p < 0.001). A similar pattern was observed for psychological well‐being. Immediately after the intervention, the mean score was 73.68 ± 13.83 in the intervention group, compared with 59.62 ± 10.24 in the control group (p < 0.001). At 2 months, the scores were 71.51 ± 12.82 and 61.34 ± 11.55, respectively (p < 0.001). Within the intervention group, scores increased significantly from baseline to both the post‐intervention assessment and the 2‐month follow‐up (p < 0.001). Changes in the control group were comparatively small. Conclusion A family‐centered empowerment intervention based on the FCEM was associated with greater improvements in health‐promoting lifestyle and psychological well‐being among patients with MS compared with routine care. Involving primary family caregivers in MS education and self‐management support may be a useful component of family‐centered care. Iranian Registry of Clinical Trials: IRCT registration number: IRCT20190917044802N12. Registration date: 10/01/2025.
