Determinants of unintended pregnancy and induced abortion among adolescent women in Ethiopia: Evidence from multilevel mixed-effects decomposition analysis of 2000-2016 Ethiopian demographic and health survey data

BACKGROUND

Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades.

METHODS

Trends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents.

RESULTS

The trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion.

CONCLUSION

The trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.

Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis

Background

Cervical cancer (CC) is the 4th most prevalent cancer among females globally. In Ethiopia, around 7,095 new CC cases are diagnosed every year and it is the second common cause of cancer deaths in women. There is limited evidence on survival status as well as about predictors of time to death among CC patients in Ethiopia. Thus, this study investigated the five-year survival status and predictors of time to death among CC patients who had been admitted at Tikur Anbesa specialized Hospital (TASH) from 2014–2019.

Methods

Facility-based, retrospective-cohort study was conducted at Tikur Anbesa specialized Hospital among 348 patients from June 2014 to June 2019. A systematic random sampling method was employed to select the study participants. Data were extracted from the patient card, and through phone calls. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Kaplan and Meier’s method was used to estimate survival functions and Cox-proportional hazard regression analysis was carried out in order to identify the independent predictors of time to death.

Results

The overall incidence of death was 31 per 100 person-years of follow up. The median (IQR) follow-up time of the entire cohorts was 18.55 (8.96–49.65) months. The independent predictors for time to death included; age older than 50 years [AHR: 1.4; 95% CI: 1.1–1.9], late stage of CC at diagnosis [AHR: 2.2; 95% CI: 1.7–2.9], No CC treatment [AHR: 2.1; 95% CI: 1.5–3.1] and HIV positive [AHR: 2.3; 95% CI: 1.4–3.8].

Conclusion and recommendation

The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient’s survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia.

Context Matters for Food Security: Multi-Sited Evidence of Shared Cultural Models of Food Consumption

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

[Neurogenetics of schizophrenia: findings from studies based on data sharing and global partnerships]

Schizophrenic psychoses are the result of a multifactorial process in which not only environmental influences but also genetic factors play an important role. These factors are based on a complex mode of inheritance that involves a large number of genetic variants. In the last three decades, biological psychiatric research has focused closely on molecular genetic aspects of the hereditary basis of schizophrenic psychoses. In particular, international consortia are combining cohorts from individual researchers, creating continuously increasing sample sizes and thus increased statistical power. As part of the Psychiatric Genomics Consortium (PGC), genome-wide association studies with tens of thousands of patients and controls have for the first time found robustly replicable markers for schizophrenic psychoses. Through intensive phenotyping, first approaches to a transdiagnostic clinical reclassification of severe mental illnesses have been established in the longitudinal PsyCourse study of the UMG Göttingen and the LMU Munich, allowing new biologically validated disease subgroups with prognostic value to be identified. For the first time environmental factors could even be examined in an African cohort that contribute to the development of the psychosis. In the coming years, the enormous technical progress in the area of genomic high-throughput technologies (next-generation sequencing) is expected to provide new knowledge not only about the influence of frequently occurring single nucleotide polymorphisms but also about rare variants. For the successful use of this technological revolution an exchange of data between research groups is essential.

Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study

BACKGROUND

In resource poor countries like Ethiopia, little is known about the survival of patients treated with antiretroviral therapy which depends on different factors. Evidence shows that mortality has been high particularly in the first 3 to 6 months of initiating antiretroviral therapy. Hence, the study aimed to assess the Epidemiology of survival pattern and its determinants among adult HIV positive patients on highly active antiretroviral therapy.

METHODS

Retrospective cohort study was employed among a total of 455 records of patients who were enrolled on antiretroviral therapy from September 2006 to August 2010. Socio-demographic, clinical, immunological, behavioral, and date of antiretroviral treatment initiation including date of follow up status were extracted. Significant predictor variables were identified by fitting Cox's proportional hazard model using a backward stepwise method and statistical significance variables were declared based on a p-value less than 0.05.

RESULTS

A total of 455 adult HIV/AIDS patients on ART contributed to 886.05-person-year of observation and 65.7% were alive and on treatment, 17.1% were lost to follow up and 7.5% died. The study showed that the estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 and 60 months of follow up period, respectively. The overall incidence rate of mortality was 4.2 per 100 person-years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI 1.21-11.4), bedridden functional status (AHR: 17.4, 95% CI 6.21-48.79), poor ART drug adherence (AHR: 4.52,95% CI 2.05-9.96), Tuberculosis co-infection (AHR: 4.1, 95% CI 1.84-9.13), non-disclosure (AHR: 4.9, 95% CI 1.82-12.89) and severe anemia (AHR: 5.1, 95% CI 1.81-14.21) were found predictors.

CONCLUSION

Patients with older age, tuberculosis infection, bedridden patients and severe anemia were predictors. Tracing poorly adhered patients and giving drug counseling as well as encouraging them for disclosure to their families is crucial to improve their survival.

Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation

BACKGROUND

Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.

METHODS

We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.

RESULTS

In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.

CONCLUSIONS

Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia's essential health services package.

Prevalence of Anemia and Associated Factors Among "Apparently Healthy" Urban and Rural Residents in Ethiopia: A Comparative Cross-Sectional Study

Background

Anemia is the most frequent micronutrient deficiency; globally it has an impact on more than 2 billion people. Different studies have indicated that the prevalence of anemia varies between rural areas and urban centers. This study focused on determining the prevalence and identifying the factors associated with anemia among “apparently healthy” urban and rural residents of Gilgel Gibe Field Research Center.

Methods and Participants

A comparative cross-sectional study was done using secondary data of Gilgel Gibe Field Research Center. Data of 1,602 (1,258 rural and 344 urban) apparently healthy adults whose hemoglobin level was available were included in the analysis. Data were analyzed by SPSS 20 and separate logistic regression models; urban and rural were fitted. Statistical significance was set at p-values < 0.05 with 95% CI.

Results

The overall prevalence of anemia was 40.9%. Anemia was higher among rural residents (46.6%) than urban residents (20.1%). In urban centers, being male (AOR = 2.15, 95% CI: [1.03, 4.50]) and illiterate (AOR = 5.76, 95% [CI: 1.27, 26.07]) were significantly associated with anemia. In rural areas, being female (AOR = 1.78, 95% CI: [1.27, 2.52]), presence of heart disease (AOR = 2.63, 95% CI: [1.09, 6.33]), central obesity (AOR = 1.83, 95% CI: [1.31, 2.57]), illiteracy (AOR = 3.62, 95% CI: [1.57, 8.35]), and primary school completion (AOR = 2.69, 95% CI: [1.08, 6.73]) were significantly associated with anemia.

Conclusion

According to the WHO classification, the overall prevalence of anemia was a severe public health problem. This study also marked urban–rural variation in anemia prevalence, indicating the need for targeting specific areas for intervention. Strengthening strategies aimed at educational empowerment and nutritional education will have a contribution to combating anemia, especially in the rural kebeles of the study area.

The CORE Group Polio Project's Community Volunteers and Polio Eradication in Ethiopia: Self-Reports of Their Activities, Knowledge, and Contributions

In 2001, the CORE Group Polio Project (CGPP) began to support polio eradication initiatives in hard-to-reach pastoralist and semi-pastoralist high-risk border areas of Ethiopia by training and supporting community volunteers (CVs) for immunization promotion and community-based surveillance activities. This article describes the development and current status of the CGPP CV network in Ethiopia. It also reports the results of a 2016 survey of CVs. Community volunteers are selected jointly by the local community, local government officials, and local health facility staff. They work closely with the health extension worker in their area and are responsible for 50-100 households. More than 12,000 CVs have been trained and have reached six million people. They make routine home visits to 1) provide education on vaccine-preventable diseases, 2) promote healthy behaviors, 3) inform parents on how to access immunization services, and 4) report cases of acute flaccid paralysis, neonatal tetanus, and measles as well as births. The 2016 survey of 675 CVs demonstrated that 84.1% had conducted home visits in the previous month to 1) identify and register pregnant mothers and newborns, 2) provide health education, 3) conduct disease surveillance, and 4) search for and register immunization defaulters. Of the CVs, 98.2% reported that their work had led to improvements in the community. Knowledge of CVs about vaccine-preventable diseases was suboptimal. CVs expressed a desire for more training. Community volunteers have made notable contributions to polio eradication efforts in high-risk areas of Ethiopia as well as to immunization promotion and disease control more broadly.

Improvements in Polio Vaccination Status and Knowledge about Polio Vaccination in the CORE Group Polio Project Implementation Areas in Pastoralist and Semi-Pastoralist Regions in Ethiopia

Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Achieving this requires improving immunization coverage in hard-to-reach areas. The objectives of this analysis were to assess levels of oral polio vaccination coverage and challenges in pastoral and semi-pastoral regions in Ethiopia. The analysis included vaccination-related data for children aged 12-23 months from the 2011 Ethiopian Demographic and Health Survey (EDHS) and from surveys carried out by the CORE Group Polio Project (CGPP) in 2013, 2015, and 2017. The EDHS data were from the entire regions (states) of Somali; Oromia; Southern Nations, Nationalities, and Peoples; Benshangul-Gumuz; and Gambella, whereas the CGPP data were for portions of these states where the CGPP was working and consisted entirely of pastoralist or semi-pastoralist populations. The overall polio immunization coverage rate showed upward trend from 39.6% in the 2011 EDHS to 72.6% for 2017 survey of children in the CGPP intervention areas. The evidence suggests that the CGPP was able to achieve increasing levels of coverage in the hardest-to-reach areas of these states and that the levels were higher than those achieved in the states as a whole. The strategies used by the CGPP/Ethiopia to increase coverage appear to have been effective. Other characteristics associated with full polio immunization included mother's religion and education, whether the mother had heard about polio, knowledge on the effect of many polio vaccine doses, and age at first polio immunization.

Trust, Communication, and Community Networks: How the CORE Group Polio Project Community Volunteers Led the Fight against Polio in Ethiopia's Most At-Risk Areas

The last case of wild poliovirus in Ethiopia was reported in 2014. Until the disease is eradicated globally, the risk of reimportation remains high. In 1999, the CORE Group Polio Project (CGPP) began its community-centered polio eradication efforts in Ethiopia, using community volunteers (CVs) to ensure that no child has missed polio vaccine. This article documents the efforts of CVs and highlights innovative strategies, successes, and contributions. Qualitative data were collected from the CGPP implementation areas in 85 border woredas (districts) of Benishangul-Gumuz; Gambella; Oromia; Southern Nations, Nationalities, and Peoples' Region; and Somali. A total of 151 in-depth interviews were conducted with CVs, parents, CGPP partners, and project stakeholders. Results of the study showed that CVs secured the buy-in of community members through open and fair eligibility and selection processes, thereby ensuring representation of community needs and perspectives. Community-driven participation consisted of identifying and choosing credible, trusted individuals who were willing to actively engage as caretakers of the community. Community volunteers then received specialized training and supportive supervision to build and expand their command of child health and vaccination information and interpersonal skills, fortifying the legitimacy of health messages and supporting the community's sense of collective efficacy. The robust network of CVs built by the CGPP continues to effectively reach the most remote, rugged, and underserved areas of Ethiopia. Stakeholders credit the CGPP with playing a significant role in keeping Ethiopia polio-free and increasing the population coverage of polio and routine immunizations.

Injury-related gaining momentum as external causes of deaths in Ethiopian health and demographic surveillance sites: evidence from verbal autopsy study

BACKGROUND

In Ethiopia, though all kinds of mortality due to external causes are an important component of overall mortality often not counted or documented on an individual basis.

OBJECTIVE

The aim of this study was to describe the patterns of mortality from external causes using verbal autopsy (VA) method at the Ethiopian HDSS Network sites.

METHODS

All deaths at Ethiopian HDSS sites were routinely registered and followed up with VA interviews. The VA forms comprised deaths up to 28 days, between four weeks and 14 years and 15 years and above. The cause of a death was ascertained based on an interview with next of families or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history and circumstances preceding death after 45 days mourning period. Two physician assigned probable causes of death as underlying, immediate and contributing factors independently using information in VA forms based on the WHO ICD-10 and VA code system. Disagreed cases sent to third physician for independent review and diagnosis. The final cause of death considered when two of the three physicians assigned underlying cause of death; otherwise, labeled as undetermined.

RESULTS

In the period from 2009 to 2013, a total of 9719 deaths were registered. Of the total deaths, 623 (6.4%) were from external causes. Of these, accidental drowning and submersion, 136 (21.8%), accidental fall, 113 (18.1%) and transport-related accidents, 112 (18.0%) were the topmost three leading external causes of deaths. About 436 (70.0%) of deaths were from the age group above 15 years old. Drowning and submersion and transport-related accidents were high in age group between 5 and 14 years old.

CONCLUSION

In this study, external causes of death are significant public health problems and require attention as one of prior health agenda.

Patients' satisfaction towards radiological service and associated factors in Hawassa University Teaching and referral hospital, Southern Ethiopia

BACKGROUND

Patient satisfaction, one of the main components of quality of care, is a crucial phenomenon for the overall health care delivery system. Even though a number of studies have been conducted about patient satisfaction in different health services, studies in radiology services are flimsy in Ethiopia. This study aimed at assessing patient satisfaction towards radiological service and associated factors in Hawassa University Teaching and Referral hospital.

METHODS

An institution based cross-sectional study was conducted among 321 adult patients presented for radiological service in the study area using stratified sampling technique. Patient satisfaction was measured using SERVQUAL (Service Quality) tool that consisted of seven items: accessibility, quality of radiological service, courtesy of radiology staff, existence of good communication with service provider and desk worker, physical environment and privacy technique. Exit interviews of patients were conducted using a structured and pretested questionnaire. Data was collected by three grade ten completed trained data collectors from May 12 to May 28, 2016. Multiple logistic regressions were used to identify independent factors associated with patient satisfaction on radiological services using SPSS version 21.

RESULTS

The overall patient satisfaction towards radiological service was 71.6%. Satisfaction to accessibility of the service was 84.5% while it was 80.6% to courtesy of the staff. Similarly, 81.6% reported satisfied with quality of the service and 59.4% and 71% of reported satisfied with physical environment and radiological service provider respectively. On the other hand, 99.7% of the respondents were dissatisfied with privacy of the service. The study revealed that patients who attended primary school (AOR = 0.317, 95% CI: 0.11-0.88), unemployed patients (AOR = 0.067, 95% CI: 0.007-0.622) and patients who had short waiting time to enter into examination room less than one hour (AOR = 4.12, 95% CI: 1.4-11.62) were factors associated with patients satisfaction.

CONCLUSION

This study found that majority of respondents was satisfied with the radiological services. Respondent's education level, occupation as well as duration of time taken to enter into examination room were important factors influencing the satisfaction condition. Hence, concerted effort is needed to constantly improve on patient satisfaction to better radiology returns arising from improved patient patronage. It is recommended to give great care and attention to clients during radiological examination procedure and also suggested that the department should decrease time taken to enter into examination room. On the other hand, the reasons behind more educated clients were less satisfied with radiologic service than more educated respondents need further investigation.

Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study

Background

Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia.

Methods

Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer.

Results

The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40–59 years), (OR= 4.7; 95%CI= 2.3–9.6), more than one husband (OR= 2.0; 95%CI=1.0–3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5–5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6–29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5–22.0) were statistically significant and the latter two were independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done.

Conclusion

Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.

Health Care Seeking Behavior in Southwest Ethiopia

Background

Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia.

Methods

Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05.

Results

Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3–63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04–15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1–5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4–33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2–8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2–110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1–10.9) among urban households showed statistically significant association.

Conclusions

The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households.

Metabolic syndrome and associated factors among outpatients of Jimma University Teaching Hospital

BACKGROUND

Developing countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult (≥20 years) patients.

METHODS

A cross-sectional hospital-based study was conducted in July 2014 among adult (≥20 years) patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program's Adult Treatment Panel III criteria.

RESULTS

A total of 225 participants were included in the study, of whom 106 (47.1%) were males and 119 (52.9%) were females. A total of 59 (26%) adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%), as compared with males, 17 (16%), (P<0.01). The most frequent metabolic syndrome parameters were hypertension (45%), hyperglycemia (39%), decreased high-density lipoprotein (HDL) (31%), central obesity (26%), and elevated triglycerides (18%). Elevated blood pressure is more common in females (44.5%) than in males (34.9%). Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P<0.001) and 6% of males versus 45% females had central obesity (P<0.001). Hypertension and body mass index were significantly lower among males (35% and 14%) than females (45% and 41%) (P<0.01 and P<0.001), respectively.

CONCLUSION

It is demonstrated that metabolic syndrome is prevalent in adult outpatients in Jimma and increases as age increases; it is more common among females than males. Among the five diagnostic criteria for metabolic syndrome, hypertension, hyperglycemia, and low HDL-cholesterol were the most prevalent. As metabolic syndrome is rising at an alarming rate, we recommend that relevant prevention, diagnostics, and therapy in adult outpatients are undertaken.

Health service utilization and reported satisfaction among adolescents in Dejen District, Ethiopia: a cross-sectional study

Background

There is no adequate health service or counseling specifically suitable for adolescents in Ethiopia. Adolescents' satisfaction on the health service provided is important to increase utilization and quality of care. The objective of this study was to assess health service utilization, reported satisfaction and predictors of satisfaction among adolescents of 15–19 years in Dejen District.

Methods

A community based cross-sectional study was done from February 05 to 17, 2012. Interview method was used to collect data from 690 adolescents. Following stratification into urban and rural, six kebeles were selected by lottery method. Study participants allocated proportionally to households' size of kebele. Households were selected randomly, and one from each household was used. Descriptive measures and binary logistic regression were used to identify independent predictors for health service satisfaction.

Result

Among 690 adolescents, 313(45%) used health service. Of these, 190 (60.7%) were satisfied. Physical proximity (AOR=3.6, 95% CI: 1.8, 7.3), drug availability (AOR=2.7, 95% CI: 1.3, 5.8), health services availability (AOR=2.5, 95% CI: 1.1, 6.0), treatment in separate room (AOR=2.9, 95% CI: 1.4, 5.6), checked all adolescents problem (AOR=4.0, 95% CI: 2.0, 8.5), treated with respect (AOR=3.0, 95% CI: 1.4, 5.7) and opportunity to explain feeling (AOR=3.3, 95% CI: 1.7, 6.6) were predictors of satisfaction.

Conclusion

Adolescents' health service utilization and satisfaction were low. Adolescents' perception of accessibility, acceptability and interaction with health workers' had significant influence on health services satisfaction. Therefore, health professionals and administrators should work on availing services with close proximity and acceptable behavior in order to increase adolescents' satisfaction.

Common mental disorder symptoms among patients with malaria attending primary care in Ethiopia: a cross-sectional survey

Background

Common Mental Disorders (CMDs) are frequent among patients attending primary care. In Africa, CMDs are often misdiagnosed as physical illnesses because many of the patients complain of somatic symptoms of mental distress. We explored whether there was difference in the levels of CMD symptoms between patients with thick film confirmed and clinical cases of malaria with negative thick film in primary care.

Methods

A cross-sectional comparative study was conducted on 300 adults with a clinical diagnosis of malaria in primary care centres in Jimma, Ethiopia. Patients were recruited consecutively until 100 cases of ‘malaria’ with a negative thick film and 200 cases of malaria with a positive thick film consented to participate. The 20-item Self-Reporting Questionnaire (SRQ-20) was used to measure CMD. The non-parametric Wilcoxon rank-sum test was used to explore the association between thick film result and CMD.

Results

Participants had a mean age of 28.2 (S.D = 10.9) years and the majority (57.3%) were women. The prevalence of high CMD symptoms (six or more symptoms on the SRQ-20) was 24.5%. Suicidal ideation was reported by 13.8% of the participants. CMD symptoms were significantly higher in patients who had taken medication prior to visiting the primary care (p = 0.012) and in those whose symptoms had been present for seven days or more (p = 0.041). There was no statistically significant association between level of CMD symptoms and having a negative thick film result (OR 0.98; 95%CI 0.92, 1.04) or objective presence of fever (OR 1.04; 95%CI 0.93, 1.15).

Conclusions

CMD symptoms among cases of malaria did not appear to be associated with a negative thick film result. The high levels of CMD symptoms, including suicidal ideation, calls for further studies to investigate the persistence and progression of these symptoms following resolution of the acute malarial episode.

Ocular manifestation of HIV/AIDS and correlation with CD4+ cells count among adult HIV/AIDS patients in Jimma town, Ethiopia: a cross sectional study

BACKGROUND

HIV/AIDS is one of twenty first century's challenges to human being with protean manifestation affecting nearly all organs of our body. It is causing high morbidity and mortality especially in sub-Saharan Africa with numerous ocular complications and blindness. The purpose of this study was to determine the patterns of ocular manifestations of HIV/AIDS and their correlation with CD4+T cells count.

METHODS

A cross-sectional study was done on 348 HIV-positive patients presented to Anti-Retroviral Therapy clinics. Data were collected using face-to-face interview, clinical examination and laboratory investigation, and analyzed using SPSS version 13 software. Statistical association test was done and p<0.05 was considered significant. Other statistical tests like student t-test and logistic regression were also done.

RESULTS

Of 348 patients, 175 were on antiretroviral therapy and 173 were not on therapy. The mean duration of therapy was 27 months. The overall prevalence of ocular manifestations was 25.3%. The commonest ocular manifestation was keratoconjunctivitis sicca (11.3%) followed by blepharitis (3.2%), molluscum contagiosum (2.6%), conjunctival squamous cell carcinoma (2.3%), conjunctival microvasculopathy (2.3%), cranial nerve palsies (2%), herpes zoster ophthalmicus (HZO) (1.2%), and HIV retinopathy (0.6%). HIV retinopathy and conjunctival microvasculopathy were common in patient with CD4+ count of <200 cells/μl while HZO and molluscum contagiosum were common in patients with CD4+ count of 200-499 cells/μl. Prevalence of ocular manifestation was higher among patients on HAART (32.6%) than those patients not on HAART (17.9%) (p<0.05). There was statistically significant association between ocular manifestation and sex, CD4+Tcells count, and age (p<0.05). CD4+ count, <200 cells/μl and age >35 years were independent risk factors for ocular manifestations.

CONCLUSION

The study showed that the prevalence of ocular manifestation of HIV/AIDS is lower than previous studies and could be due to antiretroviral therapy. Lower CD4 count is a risk as well as predictor for ocular manifestations.

Chewing over the future: khat consumption, anxiety, depression, and time among young men in Jimma, Ethiopia

This article draws on qualitative and quantitative research to examine the relationship between the consumption of khat, symptoms of depression and anxiety and the experience of time among young men in urban Ethiopia. Young men claim that khat, a mild stimulant, both causes and alleviates symptoms of depression and anxiety. However, our quantitative data indicate that there is not a direct relationship between khat and symptoms of depression and anxiety. We analyze this apparent contradiction in terms of young men's experiences of time. Long-term ethnographic research indicates that khat consumption and mental distress have a close relationship with young men's temporal problems. In a context of high urban unemployment, young men struggle to negotiate overabundant amounts of unstructured time in the present and place themselves within a narrative in which they are progressing toward future aspirations. These temporal struggles generate symptoms of depression and anxiety. For young men, khat consumption functions to reposition them in relation to time, both in the present and the future. Ultimately, we argue that the relationship between khat and time has implications for the economic issues that underlie young people's symptoms of depression and anxiety.

The prevalence of depression and associated factors in Ethiopia: findings from the National Health Survey

BACKGROUND

Integrating mental health into primarily health care and studying risk for mental health particularly depression needs assessment of different factors including those that impede diagnosis and treatment of mental disorders. But so far the numbers of literature for local context to analyze risk factors for depression and its treatment are scare. The objective of this study was to assess risk factors and health service attendance for depression among adults, in Ethiopia.

METHODS

For this analysis, data from the Ethiopian National health survey was used. The Ethiopian national health survey studied 4,925 adults aged 18 years and older to obtain among other things, data on depression episodes, socio-demographic, chronic diseases, life style factors and treatment receiving for depression episodes in the past twelve months using questionnaire from world health organization (WHO). Prevalence of Depression in respondents based on ICD-10 criteria was estimated and logistic regression analysis was used to identify risk factors for depression and treatment receiving.

RESULTS

The prevalence of depressive episode was 9.1% (95% CI: 8.39-9.90). In a Univariate analysis, residence, age, marital status, educational status, number of diagnosed chronic non communicable diseases (heart diseases, diabetic mellitus and arthritis) and alcohol drinking status were associated with depression. After full adjustment for possible confounding, odds ratios for depression were significantly higher only for older age, divorced and widowed, number of diagnosed chronic non communicable diseases and alcohol drinking status. The proportion of attending health service among those with depression episodes was 22.9%. After full control for all socio-demographic variables the only predictor variable was educational status, being in grade 5-8 had a higher odds (OR=2.6, 95% CI: 1.23-5.43) and 9-12 grade (OR=1.8 95% CI: 1.45-6.12) of attending service for depressive episodes.

CONCLUSIONS

Age, marital status, number of diagnosed chronic non communicable diseases and alcohol consumption were the most important risk factors for depressive episodes. Generally there was lower use of health service for depressive episodes and low educational status was found to be barriers for service use. There is a need to formulate policy for mental health and training of primary health care workers in mental health to early identify and treat cases with depression episodes, so as to decrease prevalence of depression episodes and to improve accessibility of service use.

Risk Factors of Active Tuberculosis in People Living with HIV/AIDS in Southwest Ethiopia: A Case Control Study

Background

Determinants of active tuberculosis among People Living with HIV/AIDS (PLHA) are not well elucidated in countries with limited resources. The objective of this study was to assess distal and proximate determinants of active tuberculosis among people living with HIV/AIDS in southwest Ethiopia.

Methods

A case-control study was conducted from January to March, 2009 in South West Ethiopia. The study population consisted of 162 cases and 647 controls. Cases were adult people living with HIV/AIDS who developed active pulmonary tuberculosis and controls were people living with HIV/AIDS without active tuberculosis. An interviewer administered structured questionnaire was used to collect information on potential risk factors.

Results

After adjustment for potential confounders, male gender (OR=1.7; 95%CI: 1.1, 2.7), a low level of education (OR=2.8; 95% CI: 1.1, 7.1), a body mass index less than 18.5 kg/m2 (OR=4.1; 95% CI: 2.3, 7.4), hemoglobin level less than 10.0 g/dl (OR=2.8; 95%CI: 1.5, 5.2), a CD4 lymphocyte count less than 200 cells/µL (OR=9.8‘95% CI: 5.5, 17.5), a WHO clinical stage IV (OR=4.3; 95% CI: 2.6, 6.8), not taking antiretroviral treatment (OR=3.1; 95%CI: 1.9,4.9), an infection with helminthes (OR=2.2; 95% CI: 1.4, 3.4), a history of contact with a tuberculosis patient in the family (OR=2.0; 95% CI: 1.2, 3.3), and living in a house made of mud wall (OR=3.7; 95% CI: 1.5, 7.5) were independently associated with the development of active tuberculosis in people living with HIV/AIDS.

Conclusion

All people living with HIV/AIDS should be screened for tuberculosis but in the presence of the risk factors mentioned above, intensified screening is recommended.

Hematoimmunological profile at gilgel gibe field research center, southwest ethiopia

BACKGROUND

Health and disease can only be distinguished by accurate and reliable reference values of a particular laboratory test. In interpreting laboratory test results, usually the reported values are compared with established reference values from developed countries. Now it is a fact that there is considerable variation in hematology reference intervals by several variables. However, such data at a population level are scanty in the Ethiopian situation. Therefore, this study was conducted to determine the hematological and immunological values in a community setting.

METHODS

A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center (GGFRC) from late September 2008 to end of January 2009. A tsample of 1,965 individuals was included in the study. Blood sample was collected by vacutainer tube and transported to Jimma University Specialized Hospital laboratory. Data were entered in to EpiData and analyzed using SPSS for Windows version 16.0 and STATA 11.

RESULTS

A total of 1965 (955 men and 1010 women) individuals were studied. The mean red blood cell count for men and women was 4.55 × 10(12)/L and 4.34 × 10(12)/L (95 percentile range between 2.9 and 5.7 × 10(12)/L) and 4.34 ×10(12)/L (95 percentile range between 2.8 and 5.2 × 10(12)/L), respectively. On the other hand, the red blood cell count of 95% of the men and women lied between 2.9-5.7 × 10(12) cells/L and 2.8-5.2 × 10(12) cells /L, respectively. The mean hemoglobin value for men was 13.6 gm/dl and for women 12.7 gm/dl. The mean corpuscular volume for men and women was 90.2 fl and 90.8 fl, respectively. The mean platelet value for men was 229.1 ×10(9) cells/L and for women 241.3 ×10(9) cells/L. The mean white blood cells count for men and women was 6.08 ×10(9) cells/L and 6.12 ×10(9) cells/L, respectively. The mean CD4 value was 809 cell/µl for men and 868 cell /µl for women. Forty two percent of the study participants had O blood group.

CONCLUSION

The hematologic and immunologic profile of the studied population in Southwest Ethiopia is different from the reports from other countries and the standards described in western literature. We recommend conducting similar nationwide study to determine the immunological and hematological reference values of the Ethiopian population as a whole.

Biochemical profile at gilgel gibe field research center, southwest ethiopia

BACKGROUND

The biochemical reference ranges currently used in developing countries are derived from data collected from populations living in developed countries. However, it is a fact that there is considerable variation in biochemical reference intervals by several variables. Moreover, reference ranges provided by different laboratory manuals and books do not also solve this problem. Biochemical profile at population level is scanty in the Ethiopian situation. Therefore, this study was conducted to determine the biochemical profiles for general population in community settings.

METHODS

A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center (GGFRC) from late September 2008 to end of January 2009. The study setting included both rural (majority) and urban dwellers. A total of 1,965 (955 men and 1010 women) individuals aged 15-64 years were included. Fasting blood glucose was determined immediately at field. Blood sample was collected by vacutainer tube without anticoagulant and transported to Jimma University Specialized Hospital laboratory for determination of total cholesterol, triglycerides, total serum protein, blood urea nitrogen, creatnine, uric acid, alanine aminotransferase and aspartate aminotransferase. Data were entered into EpiData and analyzed using SPSS for Windows version 16.0 and STATA 11.

RESULTS

The mean total cholesterol value for both sexes was 141.0 mg/dl with higher values for women at different age strata. The mean FBS level of the study population was 96 mg/dl. The mean values for blood urea nitrogen, creatinine and uric acid were 14.1 mg/dl, 0.86 mg/dl and 4.4 mg/dl. The mean level of alanine aminotransferase and aspartate aminotransferase of the study population were 27.2 U/L and 31.2 U/L, respectively.

CONCLUSION

All biochemical values in this study except for blood urea nitrogen were not different from values in other reports. Even though our finding showed similar ranges with reported values, there might be a variation in values across the country. Therefore, we recommend conducting similar nationally representative study to validate the current finding.

Physical measurement profile at gilgel gibe field research center, southwest ethiopia

BACKGROUND

Physical measurement reference values are helpful to manage patients, conduct surveillances and monitor and evaluate interventional activities. Such valuable data at a community level however, are almost non-existent in Ethiopia. The objective of this study was to determine anthropometrics and blood pressure in "apparently healthy individuals" in community settings.

METHODS

A population-based cross-sectional survey was conducted from September 2008 to January 2009 at Gilgel Gibe Field Research Center, Southwest Ethiopia. Blood pressure, height and weight were measured using Automatic Blood Pressure monitor, stadiometers and digital weight scales respectively. Waist and hip circumferences were measured using measuring tapes. BMI was computed as weight in kg divided by square of height in meter of individual (kg/m(2)). Waist to hip circumference ratio (WHR) was calculated by dividing the waist circumference to hip in centimeter. Data were entered into Epidata and analyzed using SPSS for Windows version 16.0 and STATA 11.

RESULTS

The mean systolic/diastolic blood pressures for men and women were 115.8/73.4 and 112.6/72.9 mmHg respectively. The mean BP values showed increasing trend with age for both sexes. The mean heart rate for men and women were 78.6 and 84.7 beats per minute, respectively. The mean weight and height values in all age groups, waist circumference value in 35 years and above were significantly higher (p < 0.001) for men, while the mean values for hip circumference in under 35 years and body mass index in under 45 year age groups were significantly higher (p < 0.025) for women. The mean body mass index for age group 15-24 (18.1 kg/m(2)) was significantly lower (p < 0.001) than the other age groups in men; whereas in women those 55+ years had significantly (p < 0.001) lower mean body mass index compared to the other age groups. The Waist to Hip circumference (WHC) ratio increased from 0.87 for age 15-24 years to 0.92 for those age 55 years and above. Comparison with findings in other parts of the world showed that Ethiopians (both sex) had low mean weight, waist and hip circumferences, but high body mass index.

CONCLUSION

The study showed that the physical measurement values are different from the other regions of the world. The use of other reference values in evidence based practices may result in under detection of risk groups.

Population based survey of chronic non-communicable diseases at gilgel gibe field research center, southwest ethiopia

BACKGROUND

Chronic Non-communicable Diseases are increasingly becoming more prevalent and burden to the health care system in developing countries including Ethiopia. However, evidences showing the magnitude of the problem in those countries are scarce particularly in a community setting. The objective of this study was to determine the magnitude of chronic non communicable diseases in a community.

METHODS

A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center from late September 2008 to end of January 2009. A random sample of 4,469 individuals aged 15-64 years was studied. Data on characteristics and chronic symptom inventories were collected by interviewing study participants. Blood pressure was taken three times from each individual and blood sugar and lipid levels were determined after an overnight fasting. Data were analyzed using SPSS for Windows version 16.0 and STATA 11.

RESULTS

The overall prevalence of CNCD was 8.9% (7.8% men and 9.8% women). The specific observed prevalence were 0.5% for diabetes mellitus (DM), 2.6% for hypertension, 3.0% for cardiovascular diseases, 1.5% for asthma and 2.7% for mental illness. In addition 3.1% and 9.3% of the study population had been informed to have DM and hypertension respectively.

CONCLUSION

There is a high prevalence of CNCD among the study population indicating an immediate need for preventive action and also warrant further nationally representative study.

Treatment delay among pulmonary tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia

Background

Tuberculosis (TB) is a major public health problem in Africa with Ethiopia being the most affected. Treatment delay is an important indicator of access to TB diagnosis and treatment. However, little is known about factors associated with treatment delay of pulmonary TB among pastoralists. Health facility based cross sectional study was conducted on 129 pulmonary TB patients in pastoralist community. The study was conducted in three health centers and a hospital. Time between onset of TB symptoms and first visit to a professional health care provider (patient delay), and the time between first visits to the professional health care provider to the date of diagnosis (provider's delay) were analyzed using SPSS 16.0 statistical software.

Findings

A total of 129 new smear positive pulmonary TB patients participated in the study. The median total delay was 97 days. The median patient and health provider delays were 63 and 34 days, respectively. Ninety six percent of the patients were delayed for more than the twenty one days cutoff point. Patient delay was positively associated with first visit to traditional healer/private clinic/drug shop, rural residence, being illiterate, living in more than 10 kilometers from health facility; severity of illness at first presentation to health facility. Provider delay was positively associated with rural residence, being illiterate, patient with good functional status, patients in contact with more than two health providers, and place of first visit being traditional healer/private clinic/drug shop.

Conclusions

This study showed that majority of smear positive patients delayed either for diagnosis or treatment, thus continue to serve as reservoirs of infection. This indicates that there is a need for intervention to decrease patient and provider delays. Effort to reduce delays in pastoralist communities should focus on improving access to services in rural communities, engaging traditional and private health providers and should target illiterate individuals.

Lifting the curtain on the conditions of sexual initiation among youth in Ethiopia

PURPOSE

Deriving accurate estimates of the level of sexual coercion is challenging because of the stigma that is attached to the experience. This study examines the effectiveness of a nonverbal response-card method to reduce social desirability bias in reports of the conditions of sexual initiation among youth in southwestern Ethiopia.

METHODS

The conditions surrounding sexual initiation are examined using data from a pilot survey and a final survey of youth aged 13-24 years. Half of the respondents in each survey were randomly assigned to a nonverbal response-card method for sensitive questions on sexual attitudes and behavior, and the other half of the respondents were assigned to a control group that provided verbal responses. Responses for the two groups to questions regarding the conditions of sexual initiation are compared.

RESULTS

Respondents who used the nonverbal response card were more likely to report pressure from friends or a partner, having sex for money or another gain, and rape as conditions of sexual initiation than those who provided verbal responses. Among sexually experienced youth, 29.3% of respondents who used the card method reported some form of coercion during sexual initiation compared with 19.4% of respondents who gave verbal responses.

CONCLUSIONS

The nonverbal response card provides an effective method for reducing social desirability bias when soliciting responses to sensitive questions in the context of an interviewer-administered survey. The analysis also suggests that coerced sexual initiation is underreported by youth in interviewer-administered surveys that use conventional verbal responses.

The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

Background

Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.

Methods

The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.

Results

A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.

Conclusion

Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.

Trail registration

Australian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

Background

Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.

Methods

A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.

Results

A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.

Conclusion

Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.

Trial registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022

Predictors of adherence to isoniazid preventive therapy among HIV positive adults in Addis Ababa, Ethiopia

BACKGROUND

Isoniazide preventive therapy (IPT) is given to individuals with latent infection of tuberculosis (TB) to prevent the progression to active disease. One of the primary reasons for failure of IPT is poor adherence.

METHODS

A cross sectional study was conducted in four hospitals in Addis Ababa. Data were collected using a pre-tested interviewer-administered structured questionnaire. Bivariate and multivariate analysis was done to identify predictors of IPT.

RESULTS

A total of 319 (97.5%) individual participated in this study. Within seven days recall period, self-reported dose adherence rate was 86.5%. Individual who received explanation about IPT from health care providers (OR = 7.74; 95%CI: 3.144, 19.058); who had good feeling/comfortable to take IPT in front of other people [OR = 5.981, 95%CI (2.308, 15.502)] and who attended clinical appointment regularly (OR = 4.0; 95%CI: 1.062, 15.073) were more likely to adhere to IPT. Participants who developed IPT related adverse effect were 93% less likely to adhere to the prescribed doses (OR = 0.065; 95%CI: 0.024, 0.179).

CONCLUSION

The prevalence of self reported dose adherence over the past 7 days was higher. Non-adherence was observed among respondent who were not provided with sufficient information about IPT. The health care providers need to strengthen their educational and counseling efforts to convince the patient before putting them on IPT. To enhance adherence, health education efforts should focus on the importance of IPT, the details of the regimen and adverse effects.

Household capacities, vulnerabilities and food insecurity: shifts in food insecurity in urban and rural Ethiopia during the 2008 food crisis

The global food crisis of 2008 led to renewed interest in global food insecurity and how macro-level food prices impact household and individual level wellbeing. There is debate over the extent to which food price increases in 2008 eroded food security, the extent to which this effect was distributed across rural and urban locales, and the extent to which rural farmers might have benefited. Ethiopia's food prices increased particularly dramatically between 2005 and 2008 and here we ask whether there was a concomitant increase in household food insecurity, whether this decline was distributed equally across rural, urban, and semi-urban locales, and to what extent pre-crisis household capacities and vulnerabilities impacted 2008 household food insecurity levels. Data are drawn from a random sample of 2610 households in Southwest Ethiopia surveyed 2005/6 and again in mid to late 2008. Results show broad deterioration of household food insecurity relative to baseline but declines were most pronounced in the rural areas. Wealthier households and those that were relatively more food secure in 2005/6 tended to be more food secure in 2008, net of other factors, and these effects were most pronounced in urban areas. External shocks, such as a job loss or loss of crops, experienced by households were also associated with worse food insecurity in 2008 but few other household variables were associated with 2008 food insecurity. Our results also showed that rural farmers tended to produce small amounts for sale on markets, and thus were not able to enjoy the potential benefits that come from greater crop prices. We conclude that poverty, and not urban/rural difference, is the important variable for understanding the risk of food insecurity during a food crisis and that many rural farmers are too poor to take advantage of rapid rises in food prices.

The shape of things to come? household dependency ratio and adolescent nutritional status in rural and urban Ethiopia

Several related demographic trends are occurring in developing countries: youth comprise a large portion of populations, fertility rates are declining, and urban dwellers are increasing. As fertility rates decline and populations age, the decline in the ratio of young dependents to working age adults is expected to free up household resources, which can be invested in human capital, including youth nutritional wellbeing. We test this hypothesis in a sample of youth (n = 1,934) in Southwestern Ethiopia. Multiple measures of achieved growth and nutritional status are explored (weight, height, mid-upper arm circumference (MUAC), body mass index (BMI) and body mass index for age z-score (BMIZ), weight for age z-score (WAZ), and height for age z-score (HAZ)). In multivariable models controlling for the effects of income, age, gender, and youth workloads, youth living in rural settings had significantly lower weight (1.24 kg lighter), MUAC (0.67 cm lower), BMI (0.45 BMI lower), BMIZ (0.27 lower), HAZ (0.14 HAZ lower), and WAZ (0.3 WAZ lower) than urban youth (all P < 0.01). Compared with youth in the lowest dependency ratio households, results show that youth in households with the highest dependency ratios were estimated to be 1.3 kg lighter, have 0.67 cm smaller MUAC, and BMI that was 0.59 lower (all P<0.01). Similar results were found for WAZ (0.21 lower) and BMIZ (0.36 lower). Youth height and HAZ were not associated with household dependency. These results may point toward increasing levels of human capital investments in Ethiopian youth as fertility levels decline and populations urbanize.

Household food insecurity and symptoms of neurologic disorder in Ethiopia: an observational analysis

BACKGROUND

Food insecurity (FI) has been shown to be associated with poor health both in developing and developed countries. Little is known about the relation between FI and neurological disorder. We assessed the relation between FI and risk for neurologic symptoms in southwest Ethiopia.

METHODS

Data about food security, gender, age, household assets, and self-reported neurologic symptoms were collected from a representative, community-based sample of adults (N = 900) in Jimma Zone, Ethiopia. We calculated univariate statistics and used bivariate chi-square tests and multivariate logistic regression models to assess the relation between FI and risk of neurologic symptoms including seizures, extremity weakness, extremity numbness, tremors/ataxia, aphasia, carpal tunnel syndrome, vision dysfunction, and spinal pain.

RESULTS

In separate multivariate models by outcome and gender, adjusting for age and household socioeconomic status, severe FI was associated with higher odds of seizures, movement abnormalities, carpal tunnel, vision dysfunction, spinal pain, and comorbid disorders among women. Severe FI was associated with higher odds of seizures, extremity numbness, movement abnormalities, difficulty speaking, carpal tunnel, vision dysfunction, and comorbid disorders among men.

CONCLUSION

We found that FI was associated with symptoms of neurologic disorder. Given the cross-sectional nature of our study, the directionality of these associations is unclear. Future research should assess causal mechanisms relating FI to neurologic symptoms in sub-Saharan Africa.

What Knowledge and Expectations are Ethiopian Girls Bringing with Them into Parenthood?

Background

Because of rapid population growth, many countries now have very large cohorts of young people. Despite the population health importance of early child feeding practices, little work has explored the knowledge and expectations about infant feeding that youth bring with them as they transition into parenthood.

Objective

To examine adolescent girls' perceptions of infant and young child feeding practices in their communities, and to assess their knowledge and expectations regarding infant and young child feeding practices and explore their overlap with current feeding recommendations.

Methods

Cross-sectional data were obtained from a random sample of 1,018 girls 13 to 17 years of age living in rural, semiurban, and urban sites in southwestern Ethiopia. Surveys were used to collect information on respondents' attitudes, expectations, and perceptions within the domain of infant and young child feeding practices. Descriptive and bivariate statistics were used to describe the data.

Results

A total of 1,018 girls aged 13 to 17 years were interviewed. The girls were able to report the age at which infants in their communities were provided liquids, semisolids, and solids as well as the perceived duration of breastfeeding in their communities. The girls were generally able to report when they themselves planned to provide liquids and solids to their infants and their expected duration of breastfeeding. The girls' attitudes and expectations were not consistent with exclusive breastfeeding to 6 months, and planned durations of breastfeeding were shorter than they currently perceived in their communities.

Conclusions

Young nulliparous Ethiopian women have well-formed attitudes and expectations about infant and young child feeding. These are unlikely to promote currently accepted best practices. Our results suggest both the potential that suboptimal feeding practices will be reproduced and novel intervention points.

Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia

Background

The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia.

Methods

This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden).

Results

Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)].

Conclusion

In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

Effect of training on the use of long-lasting insecticide-treated bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results of a cluster randomized trial

Background

In Ethiopia, the utilization of long-lasting insecticide-treated bed nets (LLITN) is hampered by behavioural factors such as low awareness and negative attitude of the community. The aim of this study was to present the design and baseline results of a cluster randomized trial on the effect of training of household heads on the use of LLITN.

Methods

This baseline survey was undertaken from February to March, 2009 as part of a randomized cluster trial. A total of 11 intervention and 11 control Gots (villages) were included in the Gilgel Gibe Field Research Centre, south-west Ethiopia. House to house visit was done in 4135 households to collect information about the use of LLITN and socio-demographic variables. For the diagnosis of malaria and anaemia, blood samples were collected from 2410 under-five children and 242 pregnant women.

Results

One fourth of the households in the intervention and control Gots had functional LLITN. Only 30% of the observed LLITN in the intervention and 28% in the control Gots were hanged properly. Adults were more likely to utilize LLITN than under-five children in the control and intervention Gots. The prevalence of malaria in under-five children in the intervention and control Gots was 10.5% and 8.3% respectively. The intervention and control Gots had no significant difference concerning the prevalence of malaria in under-five children, [OR = 1.28, (95%CI: 0.97, 1.69)]. Eight (6.1%) pregnant women in the intervention and eight (7.2%) in the control Gots were positive for malaria (P = 0.9). Children in the intervention Gots were less likely to have anaemia than children in the control Gots, [OR = 0.75, (95%CI: 0.62, 0.85)].

Conclusion

The availability and utilization of LLITN was low in the study area. The prevalence of malaria and anaemia was high. Intervention strategies of malaria should focus on high risk population and vulnerable groups.

Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia

STUDY DESIGN

Community-based cross-sectional analysis of the relation between symptoms of psychopathology and back pain (BP) or neck pain (NP) in rural southwest Ethiopia.

OBJECTIVE

Using data from a community-based sample, we assessed the prevalence and psychopathologic correlates of BP or NP in rural sub-Saharan Africa.

SUMMARY OF BACKGROUND DATA

BP and NP are among the most prevalent pain conditions. Psychopathology has been shown to be associated with both BP and NP in developed and urban developing contexts. Little is known about the relation between psychopathology and BP or NP in the rural, developing context.

METHODS

Data on self-reported BP and NP, symptoms of depression, anxiety, and post-traumatic stress (PTS), gender, age, and socioeconomic status were collected from a representative cohort sample (N = 900) in rural southwest Ethiopia. We calculated univariate statistics to assess the prevalence of BP and NP. We used bivariate χ2 tests and multivariate logistic regression models to assess the relation between psychopathology and BP and NP.

RESULTS

The prevalence of BP was 16.7%; that of NP was 5.0%. In χ2 analyses, symptoms of depression, anxiety, and PTS were significantly associated with increased risk for each outcome. In models adjusted for age, household assets, and gender, depression symptomatology was associated with increased risk for BP (OR = 3.44, 95% CI: 2.37-5.00) and NP (OR = 4.92, 95% CI: 2.49-9.74). Anxiety symptomatology was also associated with increased risk for BP (OR = 2.88, 95% CI: 1.98-4.20) and NP (OR = 2.67, 95% CI: 1.41-5.09). PTS symptomatology was associated with increased risk for BP (OR = 2.89, 95% CI: 1.78-4.69).

CONCLUSION

In the first known study about the relation between psychopathologic symptomatology and BP and NP in a rural context in a developing country, the prevalence of BP and NP were comparable to published data in developed and developing countries. Symptoms of depression and anxiety were correlates of BP and NP, and symptoms of PTS were a correlate of BP. Comparative studies about the relation between psychopathology and chronic pain conditions between rural and urban contexts in the global south are needed.

Minding the immunization gap: family characteristics associated with completion rates in rural Ethiopia

To examine risk factors for lack of immunization, we tested the impact of maternal, paternal, and household variables on child immunization status in children >or =1 year in a rural area of Ethiopia. Data collected by face-to-face interview on maternal, paternal, household and child variables from cross-sectional random sample community-based study on health and well-being in rural Ethiopia was used to test hypotheses on immunization status of children (n = 924). Bivariate and multivariate logistic regression models were used for two immunization outcomes: record of at least one vaccination, and record of DPT3, indicating completion of the DPT series. Complete data were available for 924 children > or =1 year of which 79% had at least one vaccination. Of those, 64% had DPT3/Polio3; below recommended coverage level. Children were more likely to be vaccinated if the mother reported antenatal care (ANC), and less likely to be vaccinated if the mother had a history of stillbirth, and no opinion of health center. Children were more likely to have DPT3 if: mother had > or =1 year of education, mother reported ANC, or older paternal age. Children were less likely to have DPT3 in households with food insecurity and no maternal opinion of health center. The study had three findings with implications for immunization programming: (1) Mothers completing the recommended ANC visits is strongly associated with receiving at least one vaccination and with completing a vaccination series; (2) Maternal education is associated with a completed vaccination series; (3) Paternal characteristics may affect vaccination series completion.

THE FORGOTTEN POPULATION? YOUTH, FOOD IN SECURITY, AND RISING PRICES: IMPLICATIONS FOR THE GLOBAL FOOD CRISIS

The global food crisis has led to increased interest in food insecurity and its causes and consequences. Much of the focus however has been on mothers and young children, with little attention paid to the possible impacts on the large population of youth in developing countries. The objectives of this paper are to (1) draw attention to the food insecurity experience of a forgotten population, youth; (2) test whether the prevalence of food insecurity among Ethiopian adolescents is increasing with the rising cost of foods; and (3) to identify some individual, household, temporal, and spatial predictors of vulnerability. Data are drawn from a baseline survey in 2006 and a follow-up survey round conducted in 2007 of an ongoing population-based longitudinal study of approximately 2,100 youth living in southwestern Ethiopia. Results show high levels of food insecurity among youth, a marked increase in the experience of food insecurity among youth, and a bias in vulnerability toward youth in the poorest households and in rural households. During the intersurvey period boys were also more likely than girls to become food insecure. This latter finding effectively eliminates the gender bias in food insecurity observed in the baseline survey. Youth who became food insecure between survey rounds were also more likely to report worse health in 2007 than in 2006. Collectively our results suggest that youth are not being adequately buffered from food insecurity, and that generalizations about the current food crisis may be too broad and, thus, misrepresent vulnerable groups. Future research should focus on how to best protect vulnerable youth from the experience of food insecurity and its consequences.

Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study

OBJECTIVES

Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among adults.

METHODS

The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms.

RESULTS

Among 902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress.

CONCLUSIONS

Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

Ethiopian adolescents' attitudes and expectations deviate from current infant and young child feeding recommendations

PURPOSE

Suboptimal infant and child feeding practices are highly prevalent in many developing countries for reasons that are not entirely understood. Taking an anthropological perspective, we assessed whether nulliparous youth have formulated attitudes and expectations in the domain of infant and child feeding behaviors, the extent to which these varied by location and gender, and the extent to which they deviated from current international recommendations.

METHODS

A population-based sample of 2077 adolescent girls and boys (13-17 years) in southwest Ethiopia answered a questionnaire on infant and young child feeding behaviors.

RESULTS

Results indicate high levels of agreement among adolescents on items relating to infant and young child feeding behaviors. Attitudes and intentions deviated widely from current international recommendations. Youth overwhelmingly endorsed items related to early introduction of nonbreast milk liquids and foods. For girls, fewer than 11% agreed that a 5-month infant should be exclusively breastfed and only 26% agreed that a 6-month infant should be consuming some animal source foods. Few sex differences emerged and youth responses matched larger community patterns.

CONCLUSIONS

The results indicate that attitudes and expectations deviate widely from current international child feeding guidelines among soon to be parents. To the extent that youth models are directive, these findings suggest that youth enter into parenthood with suboptimal information about infant and child feeding. Such information will reproduce poor health across generations as the largest cohort of adolescents ever become parents. These results suggest specific points of entry for adolescent nutrition education interventions.

Gender bias in the food insecurity experience of Ethiopian adolescents

Food insecurity is a pressing public health concern in many developing countries. Despite widespread interest in the sociocultural determinants of food insecurity, little is known about whether youths living in food insecure households experience food insecurity. The buffering hypothesis reviewed here assumes that, to the extent possible, adult members of households will buffer younger household members from the ill effects of food insecurity. A variant of the buffering hypothesis argues that only certain members of the households will enjoy the benefits of buffering. We hypothesize that within the context of Ethiopia, where girls have historically experienced discrimination, buffering is preferentially aimed at boys, especially as the household experiences greater levels of food stress. These hypotheses are tested using data from a population-based study of 2084 adolescents living in southwestern Ethiopia. Results indicate that boys and girls were equally likely to be living in severely food insecure households. Despite no differences in their households' food insecurity status, girls were more likely than boys to report being food insecure themselves. This gender difference was the largest in severely food insecure households. This same pattern was observed when comparing male-female sibling pairs living in the same household. These results are among the first to show that household level measures of food insecurity predict adolescent experiences of food insecurity, and that in the Ethiopian socio-cultural context, the relationship between household level food insecurity and adolescent food insecurity varies by gender. We also show that adolescent food insecurity is strongly associated with measures of general health and well-being.