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Mulugeta A, Eshetie TC, Kassie GM, Erku D, Mekonnen A, Lumsden A, Hyppönen E. Association Between Metabolically Different Adiposity Subtypes and Osteoarthritis: A Mendelian Randomization Study. Arthritis Care Res (Hoboken) 2023; 75:885-892. [PMID: 35313082 PMCID: PMC10952451 DOI: 10.1002/acr.24884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 03/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this Mendelian randomization (MR) study, the objective was to investigate the causal effect of metabolically different adiposity subtypes on osteoarthritis. METHODS We performed 2-sample MR using summary-level data for osteoarthritis (10,083 cases and 40,425 controls) from a genome-wide association using the UK Biobank, and for site-specific osteoarthritis from the Arthritis Research UK Osteoarthritis Genetics consortium. We used 3 classes of genetic instruments, which all increase body mass index but are associated with different metabolic profiles (unfavorable, neutral, and favorable). Primary analysis was performed using inverse variance weight (IVW), with additional sensitivity analysis from different MR methods. We further applied a nonlinear MR using UK Biobank data to understand the nature of the adiposity-osteoarthritis relationship. RESULTS Greater metabolically unfavorable and metabolically neutral adiposity were associated with higher odds of osteoarthritis (IVW odds ratio [OR] 1.56 [95% confidence interval (95% CI) 1.31, 1.85] and OR 1.60 [95% CI 1.15, 2.23], respectively). The estimate for the association between metabolically favorable adiposity and osteoarthritis was similar, although with notable imprecision (OR 1.55 [95% CI 0.70, 3.41]). Using site-specific osteoarthritis, metabolically unfavorable, neutral, and favorable adiposity were all associated with higher odds of knee osteoarthritis (OR 1.44 [95% CI 1.04, 1.98], OR 2.28 [95% CI 1.04, 4.99], and OR 6.80 [95% CI 2.08, 22.19], respectively). We found generally consistent estimates with a wider confidence interval crossing the null from other MR methods. The nonlinear MR analyses suggested a nonlinear relationship between metabolically unfavorable adiposity and osteoarthritis (Pnonlinear = 0.003). CONCLUSION Metabolic abnormalities did not explain the association between greater adiposity and the risk of osteoarthritis, which might suggest that the association is largely due to a mechanical effect on the joints.
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Affiliation(s)
- Anwar Mulugeta
- University of South Australia and South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia, and Addis Ababa UniversityAddis AbabaEthiopia
| | | | - Gizat M. Kassie
- University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Daniel Erku
- Griffith University, Nathan and Gold CoastQueenslandAustralia
| | | | - Amanda Lumsden
- University of South Australia and South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Elina Hyppönen
- University of South Australia and South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
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Koye DN, Melaku YA, Gelaw YA, Zeleke BM, Adane AA, Tegegn HG, Gebreyohannes EA, Erku DA, Tesfay FH, Gesesew HA, Mekonnen A, Dadi AF, Alene KA. Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis. BMJ Open 2022; 12:e065318. [PMID: 36600383 PMCID: PMC9743363 DOI: 10.1136/bmjopen-2022-065318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia. DESIGN AND SETTING Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources. PARTICIPANTS 9801 participants aged between 15 and 69 years. PRIMARY OUTCOME MEASURES Prevalence of hypertension and diabetes were collected using the WHO's STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km2) with corresponding 95% credible intervals (95% CrIs). RESULTS The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People's region and Addis Ababa. Population density (number of people/km2) was positively associated with the prevalence of hypertension (β: 0.015; 95% CrI: 0.003-0.027) and diabetes (β: 0.046; 95% CrI: 0.020-0.069); whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: -0.374; 95% CrI: -0.711 to -0.044). CONCLUSIONS Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia.
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Affiliation(s)
- Digsu Negese Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health research Hub (MISCH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Yohannes Adama Melaku
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Yalemzewod Assefa Gelaw
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Berihun Megabiaw Zeleke
- Planetary Health Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Akilew Awoke Adane
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
| | - Henok Getachew Tegegn
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Eyob Alemayehu Gebreyohannes
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Hailay Abrha Gesesew
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Alemayehu Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Abel Fekadu Dadi
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Menzies Health Research Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kefyalew Addis Alene
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Mekonnen A, Redley B, Crawford K, Jones S, de Courten B, Manias E. Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults. Expert Opin Drug Saf 2022; 21:985-994. [PMID: 35180833 DOI: 10.1080/14740338.2022.2044786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND : Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. RESEARCH DESIGN AND METHOD : At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Clinical and functional outcomes were collected prospectively via telephone follow-up and audit. RESULTS : Data for 232 patients (mean age 80 years, 51.7 % female) were analysed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09; 95% CI 2.38─10.85), emergency department presentation (AOR 4.69; 95% CI 1.55─14.21) and the composite outcome (AOR 6.83; 95% CI 3.20─14.57). The number rather than presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31; 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45; 95% CI 1.05─1.99). CONCLUSION : PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.
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Affiliation(s)
- Alemayehu Mekonnen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Stephanie Jones
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia
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Tessema GA, Kinfu Y, Dachew BA, Tesema AG, Assefa Y, Alene KA, Aregay AF, Ayalew MB, Bezabhe WM, Bali AG, Dadi AF, Duko B, Erku D, Gebrekidan K, Gebremariam KT, Gebremichael LG, Gebreyohannes EA, Gelaw YA, Gesesew HA, Kibret GD, Leshargie CT, Meazew MW, Mekonnen A, Mirkuzie AH, Mohammed H, Tekle DY, Tesfay FH. The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response. BMJ Glob Health 2021; 6:e007179. [PMID: 34853031 PMCID: PMC8637314 DOI: 10.1136/bmjgh-2021-007179] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O'Malley's methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.
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Affiliation(s)
- Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Yohannes Kinfu
- University of Canberra, Canberra, Australian Capital Territory, Australia
- College of Medicine, Qatar University, Doha, Qatar
| | - Berihun Assefa Dachew
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kefyalew Addis Alene
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Atsede Fantahun Aregay
- Monash University, Clayton, Victoria, Australia
- School of Nursing, Mekelle University, Mekelle, Ethiopia
| | - Mohammed Biset Ayalew
- Department of Pharmacy, University of New England, Armidale, New South Wales, Australia
- Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
| | | | - Ayele Geleto Bali
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Menzies Health Research Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | | | - Kidane Tadesse Gebremariam
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Lemlem Gebremedhin Gebremichael
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Pharmacology, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Yalemzewod Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Population Child Health Research Group, School of Women's and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hailay Abrha Gesesew
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Epidemiology, School of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Getiye Dejenu Kibret
- Public Health, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cheru Tesema Leshargie
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Alemayehu Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Alemnesh H Mirkuzie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Dejen Yemane Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Deakin University, Institute of Health Transformation, Melbourne, Victoria, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Alene KA, Gelaw YA, Fetene DM, Koye DN, Melaku YA, Gesesew H, Birhanu MM, Adane AA, Muluneh MD, Dachew BA, Abrha S, Aregay A, Ayele AA, Bezabhe WM, Gebremariam KT, Gebremedhin T, Gebremedhin AT, Gebremichael L, Geleto AB, Kassahun HT, Kibret GD, Leshargie CT, Mekonnen A, Mirkuzie AH, Mohammed H, Tegegn HG, Tesema AG, Tesfay FH, Wubishet BL, Kinfu Y. COVID-19 in Ethiopia: a geospatial analysis of vulnerability to infection, case severity and death. BMJ Open 2021; 11:e044606. [PMID: 33602713 PMCID: PMC7896372 DOI: 10.1136/bmjopen-2020-044606] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. METHODS Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km. RESULTS This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples' Region. The risk of COVID-19-related death is high in the country's border regions, where public health preparedness for responding to COVID-19 is limited. CONCLUSION This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.
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Affiliation(s)
- Kefyalew Addis Alene
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yalemzewod Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Digsu N Koye
- Department of Medicine at Royal Melbourne Hospital and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yohannes Adama Melaku
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Akilew Awoke Adane
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Muluken Dessalegn Muluneh
- Western Sydney University, Penrith South, New South Wales, Australia
- Monitoring Evaluation and Research, Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia
| | - Berihun Assefa Dachew
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Abrha
- University of Canberra, Canberra, Australian Capital Territory, Australia
- School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Atsede Aregay
- Monash University, Clayton, Victoria, Australia
- School of Nursing, Mekelle University, Mekelle, Ethiopia
| | - Asnakew Achaw Ayele
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
- University of New England, Armidale, New South Wales, Australia
| | | | - Kidane Tadesse Gebremariam
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Amanuel Tesfay Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Lemlem Gebremichael
- School of Pharmacy, Mekelle University, Mekelle, Ethiopia
- School of Pharmacy and Medical Sciences, Therapeutics Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Ayele Bali Geleto
- Haramaya University, Dire Dawa, Ethiopia
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Getiye Dejenu Kibret
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cheru Tesema Leshargie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alemayehu Mekonnen
- Deakin University, Burwood, Victoria, Australia
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Alemnesh H Mirkuzie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Henok Getachew Tegegn
- University of New England, Armidale, New South Wales, Australia
- Clinical Pharmacy Department, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Azeb Gebresilassie Tesema
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Deakin University, Geelong, Institute for Health Transformation, Melbourne, Victoria, Australia
| | | | - Yohannes Kinfu
- University of Canberra, Canberra, Australian Capital Territory, Australia
- College of Medicine, Qatar University, Doha, Qatar
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Tilahun M, Shimelis E, Wogayehu T, Assefa G, Wondimagegn G, Mekonnen A, Hailu T, Bobosha K, Aseffa A. Molecular detection of multidrug resistance pattern and associated gene mutations in M. tuberculosis isolates from newly diagnosed pulmonary tuberculosis patients in Addis Ababa, Ethiopia. PLoS One 2020; 15:e0236054. [PMID: 32750053 PMCID: PMC7402498 DOI: 10.1371/journal.pone.0236054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/27/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Multi-drug resistance is a major challenge in the control of tuberculosis. Despite newer modalities for diagnosis and treatment, people are still suffering from this disease. Understanding the common gene mutations conferring rifampicin and isoniazid resistance is crucial for the implementation of effective molecular tools at local and national levels. Hence, this study aimed to evaluate the molecular detection of rifampicin and isoniazid-resistant gene mutations in M.tuberculosis isolates in Addis Ababa, Ethiopia. METHOD Health Center-based cross-sectional study was conducted between January and September 2017 in Addis Ababa, Ethiopia. The collected sputum samples were processed for mycobacterial isolation and Region of difference 9 based polymerase chain reaction for species identification. To characterize the rifampicin and isoniazid-resistant M. tuberculosis isolates, a molecular genetic assay (GenoType MTBDRplus) was used; the assay is based on DNA-STRIP technology. RESULT Culture positivity was confirmed in 82.6% (190/230) of smear-positive newly diagnosed pulmonary tuberculosis cases enrolled in the study. From 190 isolates 93.2% were sensitive for both rifampicin and isoniazid, and 6.8% of the isolates were resistant to at least one of the tested anti-TB drugs. Gene mutations were observed in all studied multidrug resistance-associated gene loci (rpoB, katG, and inhA). Two isolates exhibited heteroresistance, a mutated, as well as wild type sequences, were detected in the respective strains. MDR-TB case was observed in 1.1% (2/190) of the cases. All the MDR-TB cases were positive for HIV and found to have a history of prior hospital admission. CONCLUSION In our finding a relatively high prevalence of any drug resistance was observed and the overall prevalence of multidrug-resistant tuberculosis was 1.1%.The majority of drug-resistant isolates demonstrated common mutations. Heteroresistant strains were detected, signaling the existence of an M.tuberculosis population with variable responses to anti-tuberculosis drugs or of mixed infections.
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Affiliation(s)
- Melaku Tilahun
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- Department of Biology, Arba Minch University (AMU), College of Natural Sciences, Arba Minch, Ethiopia
- * E-mail: (MT); (ES)
| | - Ezra Shimelis
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University (AAU), Black Lion Hospital, Addis Ababa, Ethiopia
- * E-mail: (MT); (ES)
| | - Teklu Wogayehu
- Department of Biology, Arba Minch University (AMU), College of Natural Sciences, Arba Minch, Ethiopia
| | - Gebeyehu Assefa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | - Tsegaye Hailu
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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Ahmed I, Weldegebreal T, Mekonnen A. Integrating mental health services into human immunodeficiency virus clinics: Lessons from task-sharing between clinical and lay healthcare providers in Ethiopia. ETHIOP J HEALTH DEV 2020; 34:5-13. [PMID: 36644481 PMCID: PMC9836402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Globally, mental health problems are more common among people living with human immunodeficiency virus (PLHIV) than among the general population. Mental health problems affect human immunodeficiency virus (HIV) treatment adherence and retention. To address this challenge, partners used a task-sharing approach among lay healthcare works and clinicians to integrate mental health services into HIV services at pilot hospitals in the Amhara and Tigray regions of Ethiopia. In this model, trained lay healthcare workers proactively screened patients using a mental health screening tool and subsequently linked potential clients with trained clinicians working at HIV clinics for further diagnosis and treatment. Methods We retrospectively gathered secondary data, including demographic characteristics and diagnosis information, from mental health clinicians' and case managers' quarterly reports from HIV clinics during the implementation period (January 1, 2013 to March 31, 2014). Results During the initial three-month implementation period of the project (January to March 2013), case managers screened 5,862 PLHIV for mental health disorders. Case managers referred 687 (11.7%) patients with suspected mental health disorders to clinicians for further evaluation and management. Of the total patients screened by case managers in this period, clinicians confirmed that 454 (7.7%) had a mental health disorder. Overall, the concordance between the case managers' screening results and the clinicians' diagnoses was 67.8% over the 15-month pilot implementation period. Conclusions Routine screening of PLHIV for mental health disorders helps to proactively identify and manage patients with co-morbidities. The integration of mental health services into HIV care through a task-sharing approach is a feasible strategy that could increase access to mental health services among PLHIV.
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Affiliation(s)
- Ismael Ahmed
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia.,
| | | | - Alemayehu Mekonnen
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia
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Mekonnen A, Collins JM, Aseffa A, Ameni G, Petros B. Prevalence of pulmonary tuberculosis among students in three eastern Ethiopian universities. Int J Tuberc Lung Dis 2019; 22:1210-1215. [PMID: 30236190 DOI: 10.5588/ijtld.18.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Three universities located in eastern Ethiopia: Haramaya University, Haramaya; Dire-Dawa University, Dire-Dawa; and Jigjiga University, Jigjiga. OBJECTIVE To determine the burden of pulmonary tuberculosis (PTB) among university students and to identify risk factors for the development of TB disease. DESIGN All full-time university students were screened for symptoms of PTB and sputum was collected for acid-fast bacilli (AFB) examination and culture for Mycobacterium tuberculosis. RESULTS Of 35 344 students screened, we identified 153 PTB cases that occurred over the 1-year study period, or 433/100 000 students. Of these, 117 (76%) PTB cases were found through passive case finding at student health centres, while 36 (24%) previously undiagnosed patients were identified through active case finding. Sixteen cases detected using active case finding (44%) were smear-positive. Living in a dormitory with 5 students and attending university for 2 years were both significantly associated with PTB (adjusted OR 2.49 and 3.79, respectively, P < 0.001). In persons who underwent drug susceptibility testing, 11 (30.5%) had resistance to at least one first-line anti-tuberculosis drug. CONCLUSION We found a high burden of TB among university students in eastern Ethiopia. Screening for PTB upon university admission and at regular intervals should be considered to minimise TB transmission on university campuses.
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Affiliation(s)
- A Mekonnen
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - J M Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - A Aseffa
- Armauer Hansen Research Institute, Addis Ababa
| | - G Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - B Petros
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
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Lasry A, Medley A, Behel S, Mujawar MI, Cain M, Diekman ST, Rurangirwa J, Valverde E, Nelson R, Agolory S, Alebachew A, Auld AF, Balachandra S, Bunga S, Chidarikire T, Dao VQ, Dee J, Doumatey LN, Dzinotyiweyi E, Dziuban EJ, Ekra KA, Fuller WB, Herman-Roloff A, Honwana NB, Khanyile N, Kim EJ, Kitenge SF, Lacson RS, Loeto P, Malamba SS, Mbayiha AH, Mekonnen A, Meselu MG, Miller LA, Mogomotsi GP, Mugambi MK, Mulenga L, Mwangi JW, Mwangi J, Nicoué AA, Nyangulu MK, Pietersen IC, Ramphalla P, Temesgen C, Vergara AE, Wei S. Scaling Up Testing for Human Immunodeficiency Virus Infection Among Contacts of Index Patients - 20 Countries, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:474-477. [PMID: 31145718 PMCID: PMC6542477 DOI: 10.15585/mmwr.mm6821a2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Manyazewal T, Mekonnen A, Demelew T, Mengestu S, Abdu Y, Mammo D, Abebe W, Haffa B, Zenebe D, Worku B, Aman A, Tigabu S. Improving immunization capacity in Ethiopia through continuous quality improvement interventions: a prospective quasi-experimental study. Infect Dis Poverty 2018; 7:119. [PMID: 30497515 PMCID: PMC6267782 DOI: 10.1186/s40249-018-0502-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives. This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement (CQI) interventions to improve national immunization programme performance in Ethiopia. METHODS The study used a prospective, quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors (556 healthcare facilities, 196 district health offices, and 29 zonal health departments) selected from developing and emerging regions in Ethiopia. Procedures included baseline quality assessment of immunization programme and services using structured checklists; immunization systems strengthening using onsite technical support, training, and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months; and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test. Outcome measures were the coverage of the vaccines pentavalent 3, measles, Bacillus Calmette-Guérin vaccine (BCG), Pneumococcal Conjugate Vaccine (PCV), as well as full vaccination status; while process measures were changes in human resources, planning, service delivery, logistics and supply, documentation, coordination and collaboration, and monitoring and evaluation. Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines. RESULTS Prior to the interventions, vaccination coverage was low and all seven process indicators had an aggregate score of below 50%, with significant differences in performance at healthcare facility level between developing and emerging regions (P = 0.0001). Following the interventions, vaccination coverage improved significantly from 63.6% at baseline to 79.3% for pentavalent (P = 0.0001), 62.5 to 72.8% for measles (P = 0.009), 62.4 to 73.5% for BCG (P = 0.0001), 65.3 to 81.0% for PCV (P = 0.02), and insignificantly from 56.2 to 74.2% for full vaccination. All seven process indicators scored above 75% in all regions, with no significant differences found in performance between developing and emerging regions. CONCLUSIONS The CQI interventions improved immunization capacity and vaccination coverage in Ethiopia, where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times. The approach was found to empower zone, district, and facility-level health sectors to exercise accountability and share ownership of immunization outcomes. While universal approaches can improve routine immunization, local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.
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Affiliation(s)
- Tsegahun Manyazewal
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia. .,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Alemayehu Mekonnen
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
| | - Tesfa Demelew
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
| | - Semegnew Mengestu
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
| | - Yusuf Abdu
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
| | - Dereje Mammo
- Ethiopian Medical Association, P.O. Box 2179, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Ethiopian Pediatrics Society, P.O. Box 14205, Addis Ababa, Ethiopia.,Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Belay Haffa
- Ethiopian Pediatrics Society, P.O. Box 14205, Addis Ababa, Ethiopia
| | - Daniel Zenebe
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatrics Society, P.O. Box 14205, Addis Ababa, Ethiopia
| | - Amir Aman
- Federal Ministry of Health, Government of Ethiopia, P.O. Box 1234, Addis Ababa, Ethiopia
| | - Setegn Tigabu
- Ethiopian Public Health Association, P.O. Box 7117, Addis Ababa, Ethiopia
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Salvador R, Mekonnen A, Miranda P, Ruffini G. P279: Effects of increasing the number of return electrodes in tCS. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hagos S, Shaweno D, Assegid M, Mekonnen A, Afework MF, Ahmed S. Utilization of institutional delivery service at Wukro and Butajera districts in the Northern and South Central Ethiopia. BMC Pregnancy Childbirth 2014; 14:178. [PMID: 24886375 PMCID: PMC4047000 DOI: 10.1186/1471-2393-14-178] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia has one of the highest maternal mortality in the world. Institutional delivery is the key intervention in reducing maternal mortality and complications. However, the uptake of the service has remained low and the factors which contribute to this low uptake appear to vary widely. Our study aims to determine the magnitude and identify factors affecting delivery at health institution in two districts in Ethiopia. METHODS A community based cross sectional household survey was conducted from January to February 2012 in 12 randomly selected villages of Wukro and Butajera districts in the northern and south central parts of Ethiopia, respectively. Data were collected using a pretested questionnaire from 4949 women who delivered in the two years preceding the survey. RESULTS One in four women delivered the index child at a health facility. Among women who delivered at health facility, 16.1% deliveries were in government hospitals and 7.8% were in health centers. The factors that significantly affected institutional delivery in this study were district in which the women lived (AOR: 2.21, 95% CI: 1.28, 3.82), women age at interview (AOR: 1.96, 95% CI: 1.05, 3.62), women's education (AOR: 3.53, 95% CI: 1.22, 10.20), wealth status (AOR: 16.82, 95% CI: 7.96, 35.54), women's occupation (AOR: 1.50, 95% CI: 1.01, 2.24), antenatal care (4+) use (AOR: 1.77, 95% CI: 1.42, 2.20), and number of pregnancies (AOR: 0.25, 95% CI: 0.18,0.35). We found that women who were autonomous in decision making about place of delivery were less likely to deliver in health facility (AOR: 0.38, 95% CI: 0.23,0.63). CONCLUSIONS Institutional delivery is still low in the Ethiopia. The most important factors that determine use of institutional delivery appear to be women education and household economic status.Women's autonomy in decision making on place of delivery did not improve health facility delivery in our study population.Actions targeting the disadvantaged, improving quality of services and service availability in the area are likely to significantly increase institutional delivery.
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Affiliation(s)
- Seifu Hagos
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Afework MF, Admassu K, Mekonnen A, Hagos S, Asegid M, Ahmed S. Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study. Reprod Health 2014; 11:28. [PMID: 24708848 PMCID: PMC4041359 DOI: 10.1186/1742-4755-11-28] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 03/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background Among Millennium Development Goals, achieving the fifth goal (MDG-5) of reducing maternal mortality poses the greatest challenge in Sub-Saharan Africa. Ethiopia has one of the highest maternal mortality ratios in the world with unacceptably low maternal health service utilization. The Government of Ethiopia introduced an innovative community-based intervention as a national strategy under the Health Sector Development Program. This new approach, known as the Health Extension Program, aims to improve access to and equity in essential health services through community based Health Extension Workers. Objective The objective of the study is to assess the role of Health Extension Workers in improving women’s utilization of antenatal care, delivery at health facility and postnatal care services. Methods A cross sectional household survey was conducted in early 2012 in two districts of northern and south central parts of Ethiopia. Data were collected from 4949 women who had delivered in the two years preceding the survey. Logistic regression analysis was performed to determine the association between visit by Health Extension Workers during pregnancy and use of maternal health services, controlling for the effect of other confounding factors. Results The non–adjusted analysis showed that antenatal care attendance at least four times during pregnancy was significantly associated with visit by Health Extension Workers [Odds Ratio 3.46(95% CI 3.07,3.91)], whereas health facility delivery (skilled attendance at birth) was not significantly associated with visit by Health Extension Workers during pregnancy [Odds Ratio 0.87(95% CI 0.25,2.96)]. When adjusted for other factors the association of HEWs visit during pregnancy was weaker for antenatal care attendance [Adjusted Odds Ratio: 1.35(95% CI: 1.05, 1.72)] but positively and significantly associated with health facility delivery [Adjusted Odds Ratio 1.96(1.25,3.06)]. Conclusion In general HEWs visit during pregnancy improved utilization of maternal health services. Health facility delivery is heavily affected by other factors. Meaningful improvement in skilled attendance at birth (health facility delivery) should include addressing other factors on top of visits by HEWs during pregnancy and specific target oriented interventions during visits by HEWs to support skilled attendance at birth.
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Affiliation(s)
- Mesganaw Fantahun Afework
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Brognaro E, Chang S, Cha J, Choi K, Choi C, DePetro J, Binding C, Blough M, Kelly J, Lawn S, Chan J, Weiss S, Cairncross G, Eisenbeis A, Goldbrunner R, Timmer M, Gabrusiewicz K, Cortes-Santiago N, Fan X, Hossain MB, Kaminska B, Heimberger A, Rao G, Yung WKA, Marini F, Fueyo J, Gomez-Manzano C, Halle B, Marcusson E, Aaberg-Jessen C, Jensen SS, Meyer M, Schulz MK, Andersen C, Bjarne, Kristensen W, Hashizume R, Ihara Y, Ozawa T, Parsa A, Clarke J, Butowski N, Prados M, Perry A, McDermott M, James D, Jensen R, Gillespie D, Martens T, Zamykal M, Westphal M, Lamszus K, Monsalves E, Jalali S, Tateno T, Ezzat S, Zadeh G, Nedergaard MK, Kristoffersen K, Poulsen HS, Stockhausen MT, Lassen U, Kjaer A, Ohka F, Natsume A, Zong H, Liu C, Hatanaka A, Katsushima K, Shinjo K, Wakabayashi T, Kondo Y, Picotte K, Li L, Westerhuis B, Zhao H, Plotkin S, James M, Kalamarides M, Zhao WN, Kim J, Stemmer-Rachamimov A, Haggarty S, Gusella J, Ramesh V, Nunes F, Rao G, Doucette T, Yang Y, Fuller G, Rao A, Schmidt NO, Humke N, Meissner H, Mueller FJ, Westphal M, Schnell O, Jaehnert I, Albrecht V, Fu P, Tonn JC, Schichor C, Shackleford G, Swanson K, Shi XH, D'Apuzzo M, Gonzalez-Gomez I, Sposto R, Seeger R, Erdreich-Epstein A, Moats R, Sirianni RW, Heffernan JM, Overstreet DJ, Sleire L, Skeie BS, Netland IA, Heggdal J, Pedersen PH, Enger PO, Stiles C, Sun Y, Mehta S, Taylor C, Alberta J, Sundstrom T, Wendelbo I, Daphu I, Hodneland E, Lundervold A, Immervoll H, Skaftnesmo KO, Babic M, Jendelova P, Sykova E, Lund-Johansen M, Bjerkvig R, Thorsen F, Synowitz M, Ku MC, Wolf SA, Respondek D, Matyash V, Pohlmann A, Waiczies S, Waiczies H, Niendorf T, Glass R, Kettenmann H, Thompson N, Elder D, Hopkins K, Iyer V, Cohen N, Tavare J, Thorsen F, Fite B, Mahakian LM, Seo JW, Qin S, Harrison V, Sundstrom T, Harter PN, Johnson S, Ingham E, Caskey C, Meade T, Skaftnesmo KO, Ferrara KW, Tschida BR, Lowy AR, Marek CA, Ringstrom T, Beadnell TJ, Wiesner SM, Largaespada DA, Wenger C, Miranda PC, Mekonnen A, Salvador R, Basser P, Yoon J, Shin H, Choi K, Choi C. TUMOR MODELS (IN VIVO/IN VITRO). Neuro Oncol 2013. [DOI: 10.1093/neuonc/not193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mekonnen A, Mahmoud E, Fantahun M, Hagos S, Assegid M. Maternal morbidity in Butajira and Wukro districts, North and South central Ethiopia. Ethiop Med J 2013; 51:239-248. [PMID: 24696974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Worldwide, for every woman that dies of maternal causes, there are at least 20 more women who suffer from infection, disabilities and injuries relating to pregnancy and childbirth. OBJECTIVE To determine the magnitude and the role of socio-economic, demographic and reproductive factors on the occurrence of maternal morbidity in the study population. METHODS During the months of January to February 2012, a community based cross sectional survey was conducted to assess magnitude and factors affecting maternal morbidity in selected kebeles of Wukro and Butajira districts, Tigray and Southern Nation Nationalities and People's (SNNP) regions respectively, Ethiopia. A total of 4949 women who had deliveries in the two years preceding the survey were included. Following description of variables under the study, bivariate and Multivariable statistics were used to see the relationship between different factors and maternal morbidity. RESULTS A total of 688 (14.2%) women reported that they had at least one form of morbidity. The three most frequent reported maternal morbidity during antenatal period were severe headache 89 (17.2%), lower abdominal pain (15.1%) and excessive vomiting (11.4%). Of the 220 women who reported to have morbidity during labor and delivery, prolonged labor (more than 24 hours) was accounted for 89 (40.5%) followed by hemorrhage and premature rapture of membranes in 74 (33.6%) and 23 (10.5%) of the cases respectively. Lower proportion of maternal morbidity was reported in Wukro than Butajira district [AOR (95% CI) = 0.17 (0.12, 0.25)]. Poorest and poor women were more likely to report to be sick [AOR (95% CI) = 1.79 (1.10, 2.91)] and [AOR (95% CI) = 1.65 (1.10, 2.47)] respectively. Women with parity of 5-6 and > or = 7 children respectively were also more likely to be morbid [AOR (95% CI) = 1.52 (1.11, 2.09)] and [AOR (95% CI) = 2.01 (1.38, 2.91)]. Women who had facility delivery were found more likely to have reported maternal morbidity with [AOR (95% CI) = 3.73 (2.96, 4.71)] CONCLUSION High parity, wealth status and facility delivery were found to be independent predictors of maternal morbidity. Empowering women through improving their resource generation capacity, and access to family planning services to those with high parity would diminish the likelihood of having maternal morbidity.
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Mekonnen A, Salvador R, Ruffini G, Miranda PC. The relationship between transcranial current stimulation electrode montages and the effect of the skull orbital openings. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:831-4. [PMID: 23366021 DOI: 10.1109/embc.2012.6346060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Due to its low electric conductivity, the skull has a major impact on the electric field distribution in the brain in transcranial current stimulation (tCS). However, the skull has several openings that are filled with higher conductivity soft tissues, and through which a significant fraction of the injected current may pass. We show that current entering the brain via the orbital openings increases the electric field intensity in the cortical regions near the orbit. Furthermore, this depends on the how far electrodes are placed from the orbital openings.
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Affiliation(s)
- A Mekonnen
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Lisbon, Portugal.
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Mekonnen A, Cormier M, Kimel AV, Kirilyuk A, Hrabec A, Ranno L, Rasing T. Femtosecond laser excitation of spin resonances in amorphous ferrimagnetic Gd(1-x)Co(x) alloys. Phys Rev Lett 2011; 107:117202. [PMID: 22026698 DOI: 10.1103/physrevlett.107.117202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Indexed: 05/31/2023]
Abstract
Using 100 fs laser pulses, a high-frequency exchange and a low-frequency ferromagnetic resonance mode have been excited and detected in an amorphous Gd(1-x)Co(x) (78≤x≤85) ferrimagnetic thin film, on both sides of its angular momentum compensation composition. The excitation efficiency of these modes strongly depends on the amount of laser-induced heating. Ways of selectively and efficiently exciting either one or both of these two coexisting magnetic modes by adjusting laser pulse intensity are demonstrated.
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Affiliation(s)
- A Mekonnen
- Radboud University Nijmegen, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
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Merlet I, Birot G, Molaee-Ardekani B, Mekonnen A, Salvador R, Miranda PC, Ruffini G, Wendling F. PTMS27 Simulation of scalp EEG signals under tDCS. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salvador R, Mekonnen A, Ruffini G, Miranda PC. Modeling the electric field induced in a high resolution realistic head model during transcranial current stimulation. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:2073-2076. [PMID: 21095946 DOI: 10.1109/iembs.2010.5626315] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Much of our knowledge about the electric field distribution in transcranial current stimulation (tCS) still relies on results obtained from layered spherical head models. In this work we created a high resolution finite element model of a human head by segmentation of MRI images, and paid particular attention to the representation of the cortical sheet. This model was then used to calculate the electric field induced by two electrodes: an anode placed above the left motor cortex, and a cathode placed over the right eyebrow. The results showed that the maxima of the current density appear located on localized hotspots in the bottom of sulci and not on the cortical surface as would be expected from spherical models. This also applies to the components of the current density normal and tangential to the cortical surface. These results show that such highly detailed head models are needed to correctly predict the effects of tCS on cortical neurons.
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Affiliation(s)
- R Salvador
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, Lisbon 1749-016, Portugal.
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Mekonnen A, Sophie A, Dramaix-Willmet M, Bantayehu A. Factors affecting continuity and success of community-based reproductive health service programme in rural community of Northeast Ethiopia. ACTA ACUST UNITED AC 2009; 85:487-99. [PMID: 19537425 DOI: 10.4314/eamj.v85i10.9667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess opportunities and threats towards the continuity and success of Community based reproductive health service programme in Northeast Ethiopia. DESIGN Community based comparative cross sectional study. SETTING Two districts of Amhara region, Ethiopia, classified as strong and weak community based reproductive health programme areas. SUBJECTS Seven hundred and ninety two women aged 15-49 years residing in the selected districts of Amhara region. Community based reproductive health workers, programme coordinators and field supervisors were used as informants of qualitative data collection. MAIN OUTCOME MEASURE Current use of modern contraceptive methods. RESULTS Strong versus weak programme areas: knowledge about modern contraceptive method (MCM), was (90% and 86.8%), [OR (95% CI) = 2.87(1.68,4.91)], ever use of MCM (61.1% and 29.7%), [OR (95% CI) = 3.71(2.72, 5.07)] and current use of MCM (54.8% versus 19.7%), [OR (95% CI) = 4.95(3.53,6.95)]. Method interruption was significantly higher, 37.6% in weak than 10.9% in strongly performing programme area. Causes of defaulting in strong versus weak programme areas were: wanted more pregnancy (4% and 39.5%), fear of contraceptives' side effects (16% and 31.6%) and lack of method of choice (20% and 2.6%). Type of religion, husband approval, awareness of service existence and client satisfaction remained to be the predictors of current use of MCM in multivariate analysis. Qualitative study findings were found coherent with the quantitative results. CONCLUSION Type of religion, husband approval, client satisfaction and awareness of service existence were the predictors of modern contraceptive methods utilisation in the study population.
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Affiliation(s)
- A Mekonnen
- Reproductive Health and Perinatal Epidemiology Unit, School of Public Health, Free University of Brussels, Route de Lennik 808, CP-597, B-1070, Brussels, Belgium
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Affiliation(s)
- Alemayehu Mekonnen
- a Faculty of Science, Department of Chemistry , University of Tromsø , Tromsø, Norway
| | | | - Martina Havelkova
- c Faculty of Medicine, Institute of Pharmacy , University of Tromsø , Tromsø, Norway
| | - Alexandre Descomps
- a Faculty of Science, Department of Chemistry , University of Tromsø , Tromsø, Norway
| | - Rolf Carlson
- a Faculty of Science, Department of Chemistry , University of Tromsø , Tromsø, Norway
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Assefa Y, Habte D, Yigzaw T, Mekonnen A, Gebrie T, Dubale T, Zerihun M. Trichiasis ercurrence in Nother Ethiopia: a one year prospecitve study of Trachomatous Trichiasis surgery done by integrated eye care workers. ETHIOP J HEALTH DEV 2008. [DOI: 10.4314/ejhd.v22i1.10048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bekele A, Taye G, Mekonnen Y, Girma W, Degefu A, Mekonnen A, Dejene A. Levels of outpatient satisfaction at selected health facilities in six regions of Ethiopia. ETHIOP J HEALTH DEV 2008. [DOI: 10.4314/ejhd.v22i1.10061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carlson R, Mekonnen A. An Efficient and User-Friendly Strategy for the Synthesis of Cyclopropane and Dihydrofuran Rings from Difunctional Compounds. SYNTHESIS-STUTTGART 2006. [DOI: 10.1055/s-2006-926459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mekonnen A, Carlson R. Lewis Acid Catalyzed Conjugate Addition and the Formation of Heterocycles using Michael Acceptors under Solvent-Free Conditions. European J Org Chem 2006. [DOI: 10.1002/ejoc.200500923] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kassu A, Mekonnen A, Bekele A, Abseno N, Melese E, Moges F, Wondmikun Y, Ota F. HIV and syphilis infection among elderly people in northwest Ethiopia. Jpn J Infect Dis 2004; 57:264-7. [PMID: 15623952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The prevalence of HIV has been continually increasing both in urban and rural Ethiopia. As yet, there has been no report on the magnitude of the problem in the elderly and rural population. This study assessed the seroprevalence of HIV and syphilis infection among 706 elderly and predominantly rural subjects in Northwest Ethiopia. Socio-demographic information was collected using a structured questionnaire. Venous blood was collected and the serostatus of HIV and that of syphilis were checked by ELISA and RPR, respectively. The total HIV-1 seroprevalence was 5% (35/706). Sex-specific prevalences of HIV for males and females were 5.6 and 4.7% respectively. A 4.2% difference in prevalence was observed by area of residence, which was statistically significant, P = 0.018. Only 6% of subjects positive for syphilis were also positive for HIV, while 4.9% of subjects negative for syphilis were positive for HIV. The data indicates that the prevalence of HIV among elderly people in Northwest Ethiopia was high. This indicates the importance of involving the elderly in HIV/AIDS prevention and control programs.
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Affiliation(s)
- Afework Kassu
- Department of Microbiology and Parasitology, University of Gondar, Gondar, Ethiopia.
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Mitike G, Mekonnen A, Osman M. Satisfaction on outpatient services in hospitals of the Amhara Region. Ethiop Med J 2002; 40:387-96. [PMID: 12596658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A cross sectional survey was conducted to assess patients' satisfaction on outpatient services in the hospitals of the Amara Region. A total of 898 patients from nine hospitals were interviewed on exit. The majority (95.9%) had come due to illness, and of which, 53.2% had illnesses that lasted for more than 30 days. Among those who were sick, 47.5% were non-paying (free) patients. Long waiting hours during registration, visiting of doctors after registration, laboratory procedures, and revisiting of the doctors for evaluation with laboratory results and obtaining drugs from pharmacies were associated with dissatisfaction. When logistic regression was applied, waiting time for registration, physician consultation/examination, obtaining the prescribed drugs from the pharmacies, and overall time taken to receive prescriptions were associated with dissatisfaction. Among the sociodemographic factors, age was associated with dissatisfaction. More than one-third of the patients did not get the medications prescribed in the hospital pharmacies. Failure to find the prescribed drugs was associated with dissatisfaction. Unnecessary patient delays should be reduced to the minimum by assessing hospitals' processes. Ensuring drug supply with facilitated administrative processes is recommended.
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Affiliation(s)
- Getnet Mitike
- Department of Community Health, Faculty of Medicine, Addis Ababa University, Ethiopia
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Abstract
OBJECTIVES To determine the antimicrobial susceptibility pattern of Neisseria gonorrheae and to obtain epidemiological information on resistance of Neisseria gonorrheae in Gondar town. DESIGN A cross sectional study. SETTING Gondar Health Centre. SUBJECTS One hundred and seventy eight male patients presented with urethral discharge and who volunteered to participate in the study were included. RESULTS A total of 142 strains of N. gonorrhoeae were isolated from 168 cultures received. The sensitivity of gonococcal isolates ranges from 98.6% to chloramphenicol to 7.7% to cotrimoxazole. Multiple drug resistance was reported in 87.5% of isolates and only four isolates were sensitive to all antibiotics. One strain of N. gonorrheae was resistant to as many as eight antibiotics (tetracycline, penicillin, ampicillin, kanamicin, methicilin, carbenicillin, cotrimoxazole and ceftriaxone). More than eighty five per cent of the isolated strains were penicillinase-producing Neisseria gonorrhoeae (PPNG). CONCLUSION Gonococcal resistance is a significant public health problem in Gondar region and the drugs recommended for treatment of gonococcal cases by the national sexually transmitted diseases (STDs) control programme need to be revised.
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Affiliation(s)
- A Tadesse
- Department of Microbiology, Gondar College of Medical Sciences, Ethiopia
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Abstract
After a drought and famine, overconsumption of the drought-tolerant grasspea triggered an epidemic of neurodegenerative neurolathyrism in Northeast Ethiopia. Environmental, nutritional, and medical factors seem to affect the susceptibility.
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Ahmed Z, Fenta H, Mekonnen A. Factors affecting community participation in an immunization campaign in Gondar, Ethiopia. Ethiop Med J 1979; 17:33-6. [PMID: 520298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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