Regional and Country Prevalence Estimates of Unsafe Sex Among Adolescents in 68 Low-Income and Middle-Income Countries

Prioritizing adolescent health is a public health priority to achieve the sustainable development goals, including reducing the risk of unsafe sex. Data on unsafe sex have remained scarce among adolescents in low-and middle-income countries (LMICs). To estimate the prevalence of unsafe sex in LMICs, we conducted secondary data analysis on the Global School-based Student Health Surveys among 244,863 students aged 13-17 years from 68 countries across five World Health Organization regions. The overall prevalence of ever had sex was 16.2%. The highest to lowest regional prevalence estimation of ever had sex was 30.5% (28.9-32.1) in the Americas, 28.6% (26.8-30.4) in Africa, 10.9% (9.2-12.6) in the Eastern Mediterranean, 9.6% (8.8-10.5) in South-East Asia, and 8.0% (6.8-9.1) in the Western Pacific. The highest prevalence of sexual intercourse before age 14 and practicing sexual intercourse without condom use were 36.5% (34.5-38.5) and 32.2% (30.1-34.3) in Africa, respectively. Findings suggest that current interventions are inadequate in promoting the uptake of safe sexual behaviors and an urgent intervention is needed.

Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia

Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.

Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder

BACKGROUND

Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample.

METHODS

Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001.

RESULTS

The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger.

CONCLUSION

UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.

Perceived compassionate care and associated factors among patients with mental illness at Tibebe Ghion specialized and Felege Hiwot comprehensive specialized hospital, Northwest Ethiopia

BACKGROUND

Compassion is the first ethical principle of health care to provide high- quality care that influences patient satisfaction and treatment outcome. However, there is limited data on the level of compassionate mental health care practice in low-resource countries like Ethiopia.

OBJECTIVES

This study aimed to assess the level of perceived compassionate care and associated factors among patients with mental illness at Tibebe Ghion specialized and Felege Hiwot comprehensive specialized hospital, North West, Ethiopia, 2022.

METHODS

An institutional-based cross-sectional study design was conducted from June 18 to July 16, 2022, at Tibebe Ghion Specialized and Felege Hiwot Comprehensive Specialized Hospital. A systematic random sampling technique was used. The level of perceived compassionate care was assessed by the validated 12-item Schwartz Center Compassionate Care Scale among 423 patients with mental illness. Epicollect-5 was used to collect data, which was then exported to the Statistical Product and Service solution version 25 for analysis. Variables with a P-value < 0.05, and 95% confidence interval (CI) were used to declare significant variables at the multivariate logistic regression analysis.

RESULT

The level of perceived good compassionate care was 47.5% (95% CI 42.6%-52.4%). Factors including urban residence (AOR = 1.90; 95%CI 1.08-3.36), duration of illness < 24 months (AOR = 2.68; 95% CI 1.27-5.65), strong social support (AOR = 4.43; 95%CI 2.16-9.10), shared decision making (AOR = 3.93; 95% CI 2.27-6.81), low perceived stigma(AOR = 2.97; 95% CI 1.54-5.72) and low patient anticipated stigma (AOR = 2.92; 95% CI 1.56-5.48) were positively associated with good compassionate care.

CONCLUSION AND RECOMMENDATION

Less than half of the patients had received good compassionate care. Compassionate mental health care needs public health attention. Policymakers should emphasize on compassionate care continuity by including it in the health care curriculum and design appropriate policies to strengthen compassionate care.

Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted.

RESULTS

The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults.

CONCLUSIONS

Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.

Association between polarity of first episode and solar insolation in bipolar I disorder

OBJECTIVE

Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth.

METHODS

Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer.

RESULTS

The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001).

CONCLUSION

Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.

Magnitude and determinants of suicide among overweight reproductive-age women, Chacha and Debre Berhan Town, Ethiopia: community based cross-sectional study

Background

The magnitude and impact of women's suicidal behaviors, like suicidal ideation and suicidal attempts, are an important public health problem in low and middle-income countries, including Ethiopia. Suicidal behavior and being overweight are typical complications of reproductive age with many undesired consequences. Despite both having a serious impact on women of reproductive age, they are neglected in Ethiopia. Accordingly, this study aimed to examine the magnitude and determinants of suicide among overweight reproductive-age women in Chacha and Debre Berhan towns, Ethiopia.

Methods

A community-based cross-sectional study design was once employed from April 1, 2020 to June 1, 2020. The Composite International Diagnostic Interview was used to measure suicidal attempts and ideation, and the data was collected by direct interview. All collected data were entered into Epi Data version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable regression models were used to determine the factors associated with a suicidal attempt and ideation. A p-value of less than 0.05 was considered statistically significant.

Result

Of the total participants, 523 were included, with a response rate of 93.7%. The prevalence of suicidal ideation was 13.0% (95% CI 10.1–15.9), whereas suicidal attempt was 2.3% (95% CI 1.1–3.6). Based on multivariable regression analysis, the odds of suicidal ideation have been higher among overweight women with stressful life events, depression, and younger age groups.

Conclusion

Suicidal ideation was frequent in overweight reproductive-age women. Preventing, treating, and using coping mechanisms regarding identified factors is a good way to minimize the burden of suicide.

Prevalence and determinants of aggressive behavior among adults with problematic substance use in Northwest Ethiopia: a cross-sectional survey

BACKGROUND

The recent WHO data reported that a high treatment gap for behavioral illnesses (70%) in low- and- middle-income countries and the mortality rate of aggressive behavior reaches up to 32.1 per 100,000 populations in the region. However, the magnitude of aggressive behavior is not well stated in resource-limited settings. Therefore, the aim of this study was to assess the prevalence and determinant factors of aggressive behavior among adults with problematic substance use in northwest Ethiopia.

METHODS

A community-based cross-sectional study was employed from January to March 2019. A multi-stage cluster sampling method was used to screen a total of 4028 adults for problematic substance use by using the Cutdown, Annoyed, Guilty, and Eye-opener questionnaire (CAGE AID). Finally, 838 participants were positive for problematic substance use and interviewed for aggressive behavior using a modified overt aggression scale. Multiple logistic regression analysis was used to show the adjusted odds ratios (AOR) and p-value < 0.05 considered statistically significant. A multilevel binary logistic regressions model was employed for the hierarchical structure of two-level data for the individual and woreda/district levels.

RESULTS

The prevalence of aggressive behavior was found to be 37.9% (301/795, 95% CI: 34.5, 41.3). Stressful life events (AOR = 2.209, 95 CI; 1.423, 3.429), family history of mental illness (AOR = 4.038, 95 CI; 2.046, 7.971), comorbid physical illness (AOR = 2.01, 95 CI; 1.332, 3.032) and depressive symptoms (AOR = 2.342, 95 CI; 1.686, 3.253) were associated with aggressive behavior among individual with problem substance use.

CONCLUSION

Aggressive behavior was found to be high among problematic substance uses. An individual with problematic substance use is recommended to be screened by health extension workers for aggressive behavior at the community level.

Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background

Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries.

Methods

Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries).

Results

This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01.

Conclusion

A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

Depressive symptoms among people with HIV/AIDS in Northwest Ethiopia: comparative study

OBJECTIVES

The objective of this study was to compare depressive symptoms among people with HIV/AIDS and the general population sample. We also assessed the factors associated with depressive symptoms.

DESIGN

A comparative cross-sectional study was conducted.

SETTINGS

Antiretroviral therapy clinics in three primary healthcare facilities and semi-urban area in Northwest Ethiopia.

PARTICIPANTS

A total of 1115 participants (558 people with HIV/AIDS and 557 comparison group) aged 18 years and above were recruited. A total of 1026 participants (530 people with HIV/AIDS and 496 comparison group) completed the interview. We excluded people with known HIV-positive status from the comparison group.

OUTCOME MEASURE

Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The proportion of depressive symptoms was compared between samples of the general population and people with HIV/AIDS using χ2 statistics. Multivariable logistic regression analysis was done to examine the associated factors.

RESULTS

The overall prevalence of depressive symptoms was 13.3% (11.2%-15.4%). The prevalence was significantly higher in people with HIV/AIDS compared with the community sample (16.6% vs 12.3%), p=0.001. The difference was also significant in the multivariable logistic regression (OR 1.7). For the overall sample, depressive symptoms were significantly associated with older age, being single, divorced/widowed marital status, and poor social support.

CONCLUSIONS

Depressive symptoms were higher in people with HIV/AIDS compared with the general population. It is necessary to include mental healthcare and screening for depression in routine HIV/AIDS care.

High-level of anxiety and depressive symptoms among patients with general medical conditions and community residents: a comparative study

BACKGROUND

The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia.

METHODS

Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant.

RESULTS

A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value < .0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms.

CONCLUSIONS

Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center.

Perceived stigma and associated factors among adults with problematic substance use in Northwest Ethiopia

Background

Substance use-related problems including cigarette smoking and alcohol use are among leading preventable risk factors for premature death. However, people with these problems did not get the appropriate treatment they need. Stigma against substance use could be the potential barrier for people with problematic substance use to seek professional help. Therefore, the objective of this study was to investigate magnitude and associated factors of perceived stigma towards problematic substance use.

Methods

A total of 2400 participants were screened using the Cut down, Annoyed, Guilty, and Eye-opener (CAGE) Adapted to Include Drugs (CAGE-AID) questionnaire. We found 540 participants screened positive for problematic substance use (alcohol, hashish, tobacco and khat) and interviewed them for perceived stigma using Perceived Stigma of Substance Abuse Scale (PSAS). Logistic regression was used to examine associated factors with perceived stigma.

Results

Three hundred forty-five (63.9%) participants reported perceived stigma above the mean value of Perceived Stigma of Substance Abuse Scale (PSAS). Variables positively associated with perceived stigma were lower wealth and joblessness, history of separation from family members before age of 18 years, poly-substance misuse and awareness about economic crisis of substance use.

Conclusion

Approximately, three in five people with problematic substance use perceived having been stigmatized by others. Health planning for problematic substance use should focus on stigma.

Prevalence of Depression and Associated Factors Among Normal and Overweight Reproductive Age Women, Ethiopia: Community-Based Comparative Cross-Sectional Study

Background

Depression and overweight are serious public health problems and the most common complications of childbearing age with many negative consequences on the mental health of women and their children in the world. Even though both have a serious impact, no study has been done in Ethiopia. Therefore, this study aimed to assess and compare the prevalence of depression and associated factors among normal and overweight reproductive-age women in Debre Berhan town.

Methods

A community-based comparative cross-sectional study was conducted from April– June 2020. Patient health questionnaire-9 was used to measure the level of depression and list of threatening experience for stressful life events. Body mass index values of 18.5–24.9 and 25–29.9 kg/m² were used to classify as normal, and overweight, respectively. The data were entered into Epi Data V. 4.6 and were analyzed using SPSS V. 25. A statistically significant association was declared at a p-value < 0.05.

Results

From 1530 participants the response rate were 96.1% and 100% for normal and overweight women, respectively. The prevalence of depression among normal weight women was 26.02% (95% CI: 23.3%, 28.73%) whereas among overweight was 32.89% (95% CI: 28.85%, 36.93%). For women who have normal weight; being exposed to stressful life events, having poor social support, and body image disturbance were statistically significant factors. For women who have overweight, stressful life events, body image disturbance, and experienced weight stigma were significantly associated.

Conclusion and Recommendation

Depression among overweight women was high compared to normal weight in Debre Berhan town. Promoting social support at any aspect of health care services are very important to minimize depression. Especially for overweight women, encouraging management of medical illness, coping mechanisms for different stressful life events and potentiating self-confidence towards body image are a vital means to prevent depression. Health promotion program targeting reproductive age women with significant associated factors are important to overcome overweight and depression in Debre Berhan town.

Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review

Introduction:

In Ethiopia, the burden of HIV/AIDS is a public health issue that requires significant control of transmission. Once an infection has been established, determinants influence people living with HIV to disclose or not their HIV-positive status to sexual partners. This study assessed the proportion and associated factors of people living with HIV’s disclosure status to sexual partners.

Methods:

CRD42020149092 is the protocol’s registration number in the PROSPERO database. We searched PubMed, Scopus, African Journals Online, and Google Scholar databases. For the subjective and objective assessment of publication bias, we used a funnel plot and Egger’s regression test, respectively. The I² statistic was used to assess variation across studies. Meta-analysis of weighted inverse variance random-effects model was used to estimate the pooled proportion. We conducted subgroup and sensitivity analyses to investigate the cause of heterogeneity and the impact of outliers on the overall estimation, respectively. A trend analysis was also performed to show the presence of time variation.

Results:

The percentage of people living with HIV who disclosed their HIV-positive status to sexual partners was 76.03% (95% confidence interval: 68.78, 83.27). Being on antiretroviral therapy (adjusted odds ratio = 6.19; 95% confidence interval: 2.92, 9.49), cohabiting with partner (adjusted odds ratio = 4.48; 95% confidence interval: 1.24, 7.72), receiving HIV counseling (adjusted odds ratio = 3.94; 95% confidence interval: 2.08, 5.80), having discussion prior to HIV testing (adjusted odds ratio = 4.40; 95% confidence interval: 2.11, 6.69), being aware of partner’s HIV status (adjusted odds ratio = 6.08; 95% confidence interval: 3.05, 9.10), positive relationship with partner (adjusted odds ratio = 4.44; 95% confidence interval:1.28, 7.61), and being member of HIV association (adjusted odds ratio = 3.70; 95% confidence interval: 2.20, 5.20) had positive association with HIV status disclosure.

Conclusion:

In Ethiopia, more than one-fourth of adults living with HIV did not disclose their HIV-positive status to sexual partners. HIV-positive status disclosure was influenced by psychosocial factors. A multidimensional approach is required to increase seropositive disclosure in Ethiopia.

Prevalence and Associated Factors of Suicidal Behavior Among Patients and Residents in Northwest Ethiopia

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p-value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5-6%). It was found to be 4.4% with 95% CI range 4-5% in residents and 7.9% with 95% CI range 6-9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries.

Work-Related Stress and Associated Factors Among Textile Factory Employees in Northwest Ethiopia: A Cross-Sectional Study

Background

Work-related stress is becoming an alarmingly growing public health concern worldwide. Textile factories are among the most common manufacturing industries that have a higher rate of work-related stress. Investigating the prevalence and factors associated with work-related stress will help planners and decision-makers at every level in planning, managing, and evaluating the health status of the employees. Research evidence is limited for work-related stress in Northwest Ethiopia. Therefore, this study was aimed to assess work-related stress and associated factors among textile factory employees in Northwest Ethiopia.

Methods

A cross-sectional study design was employed among 403 employees in Bahir Dar Textile Factory. Data were collected using an interviewer administered questionnaire, then entered into EpiData version 3.1, and analyzed using SPSS version 22 software. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. In logistic regression analysis, adjusted odds ratio (AOR), along with 95% confidence interval (CI), was used to identify the associated factors of work-related stress. A P-value<0.05 was considered as statistically significant.

Results

The prevalence of work-related stress was 45.2%, with 95% CI=40.0–50.1%. Working in rotational shifts (AOR=2.33, 95% CI=1.34–4.03), current substance use (AOR=5.67, 95% CI=3.38–9.52), poor and medium social support (AOR=3.75, 95% CI=1.71–8.21 and AOR=3.26, 95% CI=1.39–7.64) were significantly associated factors with work-related stress, respectively.

Conclusion and Recommendation

Near to half of the study participants had work-related stress. Work shift, substance use, and social support were among the factors which affect work-related stress. Thus, interventions that could reduce work-related stress such as stress management programs should be considered.

The Effect of Early Childhood Sexual Abuse on Mental Health Among Postpartum Women Visiting Public Health Facilities in Bahir Dar City, Ethiopia: Multicenter Study

Background

There is a scarcity of evidence regarding the effects of early childhood sexual abuse on mental health among women in Sub-Saharan Africa. The purpose of this study was to assess the proportion of postpartum depression and associated factors among postnatal women in care in public health facilities of Bahir Dar city, northwest Ethiopia. This study also aimed at evaluating the effect of early childhood sexual abuse on postpartum depression.

Methods

A multicenter cross-sectional study was conducted among 988 postpartum women in care at Bahir Dar city’s public health facilities. A two-stage sampling technique and interviewer administered structured questionnaire were utilized. Edinburgh Postnatal Depression Scale (EPDS) with a cutoff point of ≥ 12 was employed to report postpartum depression. Binary logistic regression model was fitted and the level of significance was reported based on AOR with 95% CI at p-value of < 0.05.

Results

The prevalence of postpartum depression was 33.8% (95% CI: 31, 37) and 55.3% (95% CI: 46, 64) among all study participants and mothers having a history of childhood sexual abuse, respectively. Participants’ age of < 25 years (AOR = 3.1; 95% CI: 1.9, 5.3) and 25–34 years (AOR= 2.0; 95% CI: 1.3, 3.2), family size of >5 (AOR = 2.5; 95% CI: 1.1, 5.7), alcohol use (AOR = 2.2; 95% CI: 1.6, 2.9), history of childhood sexual abuse (AOR = 2.8; 95% CI: 1.9, 4.3), joblessness (AOR = 1.4; 95% CI: 1.1, 1.9) and growing up with biological mothers (AOR = 0.5; 95% CI: 0.4, 0.8) have stastical significant association with postpartum depression as compared to the respective reference group.

Conclusion

A significantly higher burden of postpartum depression was observed among mothers with a history of childhood sexual abuse. Thus, controlling childhood sexual abuse and other psychosocial determinants would improve maternal mental wellness.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study

BACKGROUND

While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

METHODS

In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

RESULTS

GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

CONCLUSIONS

GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017

BACKGROUND

Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

METHODS

We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

FINDINGS

In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

INTERPRETATION

Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Suicidal behaviour in postnatal mothers in northwestern Ethiopia: a cross-sectional study

AIM

To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers.

METHOD

An institutional cross-sectional study was employed from March to April 2017.

SETTING

Two primary health centres and one referral hospital in northwestern Ethiopia.

PARTICIPANTS

A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included.

OUTCOME MEASURE

Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance.

RESULTS

The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours.

CONCLUSION

Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care.

Help seeking behavior for problematic substance uses in north-West Ethiopia

Background

Substance miss use and neuro-psychiatric conditions are a growing public health challenges, but 76 to 85% of people with those disorders in low and middle-income countries did not receive treatment. The aim of this study was to see help seeking behavior and determinant factors in residents with problematic substance uses.

Methods

A total of 2400 participants had screened for problematic substance uses and 548 participants were found positive for problematic substance uses. Then, we had interviewed 548 participants for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression with its corresponding p-value < 0.05; Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used.

Results

Among five hundred and forty-eight participants with problematic substance use, only one hundred and sixty-eight (30.7%) with 95% CI (27, 35%) had sought help. Age above 35 years [AOR = .47 95% CI (.25, .90)], who had common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], who had comorbid medical condition [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families’ history of substance use [AOR = 2.18, 95% CI (1.4, 3.4)] were significantly associated with help seeking behavior.

Conclusion

Help-seeking behavior was infrequent in people with problematic substance use. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050

BACKGROUND

Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries.

METHODS

We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health.

FINDINGS

Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending.

INTERPRETATION

Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets.

FUNDING

Bill & Melinda Gates Foundation.

Incidence of Post-Traumatic Stress Disorder After Road Traffic Accident

Background: Post-traumatic stress disorder (PTSD) occurs after exposure to actual or threatened death, serious injury, or sexual violence. Road traffic accident (RTA) is one of the traumatic experiences, which may result in PTSD. But treatment is mainly concentrated on physical health. This may be due to a lack of evidence in low-income countries. Aim: To determine the incidence level and identify risk factors of PTSD after RTA. Methods: Longitudinal panel study was done to assess the incidence of PTSD after RTA. The study was conducted in three orthopedic settings of Bahir Dar town Northwest, Ethiopia. The study was on 299 adult car accident survivors. PTSD Checklist (PCL) civilian version, Sheehan disability assessment scale, Patient Health Question (PHQ-2), and Alcohol Use Disorder Identification Test (AUDIT) were instruments to assess the outcome and associated factors. The generalized linear model with Poisson log-linear method was applied to identify associated factors. Ethical clearance was obtained from Bahir Dar University. Individuals with PTSD symptoms were linked to the psychiatric clinic. Result: One hundred thirty-nine (46.5%) participants had at least three extremely severe symptoms that fulfil criteria B, C, and D of Diagnostic Statistical Manual IV of PTSD. The most frequent severe symptoms were having repeated, disturbing memories, thoughts, or images. Two hundred ten (70.2%) participants reported the extreme impact of the accident on work or schooling and 156 (51.9%) reported extreme problems in social functioning. Alcohol dependence, hazardous alcohol consumption, and harmful use were reported by 7.9%, 15.1%, and 4.7% of the participants, respectively. In the final model witnessing death, severe sleep problem and severe impairment in family functioning were significantly associated with PTSD. Conclusion: Nearly half of RTA survivors develop PTSD. Clinicians need to link these patients to the psychiatry clinic. Special attention should be given to patients who witnessed death, with a serious disability, and previous psychiatric history.

Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review

BACKGROUND

Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia.

RESULTS

Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072-0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059-0.664)] were the determinant factors for poor outcome of neonatal sepsis.

CONCLUSION

The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.

Use of physical restraints among patients with bipolar disorder in Ethiopian Mental Specialized Hospital, outpatient department: cross-sectional study

Background

Even though United Nation announced that all persons with a mental illness shall be treated with humanity and respect for the inherent dignity of the human being, up to now, the use of coercion (physical restrain) is still considered as unavoidable in managing abnormal behavior of psychiatric patients. But, there is no information regarding the magnitude and contributing factors of physical restrain among bipolar patients in low-income countries like Ethiopia.

Methods

A cross-sectional study was conducted at Amanuel Mental Specialized Hospital from May 1 to June 1, 2015 among 400 participants who were selected by systematic random sampling technique. Data were collected by interviewing; adjusted odd ratios (AOR) with 95% confidence intervals (CI) were used and p value <0.05 was considered as statistically significant.

Results

The prevalence of physical restrain was 65%. Factors like, having two or more episodes [AOR = 1.84 95% CI (1.16, 2.93)], history of aggression [AOR = 2.14, 95% CI (1.26, 3.63)], comorbid illness [AOR = 1.76, 95% CI (1.26, 3.63)], use of antipsychotic [AOR = 1.79, 95% CI (1.08, 2.95)] and current use of Khat [AOR = 1.83, 95% CI (1.10, 3.04)] were associated significantly.

Conclusions

The prevalence of physical restraint is found high among bipolar patients and it needs public health attention.

Leveling and abuse among patients with bipolar disorder at psychiatric outpatient departments in Ethiopia

INTRODUCTION

The World Health Organization (WHO) clearly states the importance of psychological well-being in the definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". However, in the community, the lives of people with bipolar disorders are often harsh and abusive. Till now, the rate and related information concerning verbal or physical abuse among patients with bipolar disorder at psychiatric outpatient clinics have not been well addressed in Ethiopian settings.

METHODS

Data were collected by interviewing 411 systematically selected participants at outpatient department of Amanuel Mental Specialized Hospital. For analysis, logistic regression and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used, and P  < 0.05 was considered statistically significant.

RESULTS

The prevalence of abuse (verbal/physical) was 37.7%. Having two or more episodes [AOR 1.70, 95% CI (1.06, 2.74)], a history of aggression [AOR 3.06, 95% CI (1.63, 5.75)] and comorbid illness [AOR 2.21, 95% CI (1.25, 3.90)] were significantly associated.

CONCLUSION

The prevalence of reported abuse is high among patients with bipolar disorder, and it is important to remember the rights of patients during treatment.

Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study

BACKGROUND

Aggressive behavior is a challenging behavior among bipolar patients that causes poor social interaction and hospitalization. But, there is no information regards of the magnitude and contributing factors for aggressive behaviour among bipolar patients in Ethiopia. Therefore, this study was designed to assess the prevalence and associated factors of aggressive behaviour among patients with bipolar disorder.

METHOD

An institutional based cross sectional study was conducted at Amanual Mental Specialized Hospital from May 1 to June 1, 2015 among 411 participants who were selected by systematic random sampling technique. Data was collected by interview technique by using Modified Overt Aggression Scale, entered and analyzed by using Epi Data 3.1 and Statistical Package for Social Science version 20, respectively. Adjusted Odd Ratio (AOR) with 95% Confidence Interval (CI) were used to show the odd and P-value <0.05 was considered as statistically significant.

RESULTS

A total of 411 bipolar patients were included in the study and the prevalence of aggressive behaviour was 29.4%. Significant associated factors for aggression were, having two or more episode [AOR = 2.35 95% CI (1.18, 4.69)], previous history of aggression, [AOR = 3.72, 95% CI (1.54, 8.98)], depressive symptoms [AOR = 3.63, 95% CI (1.89, 6.96)], psychotic symptoms [AOR = 5.41,95% CI (2.88, 10.1)], manic symptoms [AOR = 3.85,95% CI (2.06, 7.19)], poor medication adherence [AOR = 3.73 95% CI (1.71, 8.13)], poor social support [AOR = 2.99 95% CI (1.30, 6.91)] and current use of substance[AOR = 2.17 95% CI (1.16, 4.06)].

CONCLUSION

Prevalence of aggression is high among bipolar patients and associated with many factors. So it needs public health attention to decrease aggression among bipolar patients.

Satisfaction and associated factors of outpatient psychiatric service consumers in Ethiopia

PURPOSE

The purpose of this study was to assess the level of patient satisfaction and associated factors with psychiatric outpatient services in Ethiopia.

PATIENTS AND METHODS

A cross-sectional study was performed from May 2015 to June 2015. A total of 454 participants selected by systematic random sampling were included in this study. Pretested and interviewer-administered questionnaire was used to collect the data. Patient satisfaction was measured using Charleston Psychiatric Outpatient Satisfaction Scale, and other validated tools were used to assess the associated variables. Multivariate logistic regressions with 95% confidence interval (CI) were used to assess the strength, and P-value <0.05 was used to indicate significance of association.

RESULTS

A total of 441 respondents were enrolled, with a response rate of 97.1% and magnitude of satisfaction of 61.2%. Being male (adjusted odds ratio [AOR] =0.612, 95% CI: 0.39, 0.94), being widowed (AOR =0.13, 95% CI: 0.05, 0.36), urban residence (AOR =0.49, 95% CI: 0.31, 0.78), diagnosed with schizophrenia (AOR =0.48, 95% CI: 0.28, 0.81), unfavorable attitude (AOR =0.49, 95% CI: 0.28, 0.86), and poor social functioning (AOR =0.52, 95% CI: 0.34, 0.80) were significantly associated with satisfaction.

CONCLUSION

More than one-third of psychiatric service consumers were dissatisfied with the service they received. Integrating patients to their own treatment plan and regular service evaluation are important to improve satisfaction.

Wheeze, allergic sensitization and geohelminth infection in Butajira, Ethiopia

BACKGROUND

The effect of geohelminth infection on wheeze and allergen sensitization is inconsistent across different epidemiological studies.

OBJECTIVE

To investigate the association between self-reported wheeze, self-reported asthma, allergic sensitization and geohelminth infection in urban and rural areas of Butajira, southern Ethiopia.

METHODS

Questionnaire data on wheeze, asthma and a range of confounding variables was gathered in a cross-sectional study of 7649 people aged 5 years or more from the Butajira Rural Health Project database. Allergic skin sensitization to Dermatophagoides pteronyssinus and cockroach was measured, and a stool sample collected for qualitative and quantitative geohelminth analysis.

RESULTS

Wheeze was weakly associated with allergic sensitization to D. pteronyssinus and cockroach (odds ratios (OR) 1.21, 95% confidence interval (CI) 0.98-1.51, and 1.27, 95% CI 1.00-1.62, respectively). Self-reported asthma was related to sensitization to D. pteronyssinus only (OR 4.09, 95% CI 2.86-5.84). Geohelminths were present in 33.8% of participants, and the median egg load in infested individuals was 6 eggs/g. Overall, presence of any geohelminths was associated with a diminished risk of cockroach sensitization (adjusted OR 0.82, 95% CI 0.68-0.99) but there were no significant protective effects of any geohelminth infection against wheeze or asthma.

CONCLUSION

In a developing country community with relatively low geohelminth prevalence and intensity, we found weak association between allergic sensitization and wheeze, but no evidence of a protective effect of geohelminths against wheeze or asthma.

Control of human African trypanosomiasis: trap and odour preference of tsetse flies (Glossina morsitans submorsitans) in the upper Didessa river valley of Ethiopia

Ethiopia is one of the endemic countries for Human African Trypanosomiasis (HAT) as over 100,000 people are at risk of having the disease. The control of HAT using odour preference of tsetse flies (Glossina morsitans submorsitans) was studied in upper Didessa river valley of Ethiopia. No information exists on the effectiveness of attractants for these species of tsetse flies in Ethiopia. Three attractants and their combinations namely: acetone, octenol, cow urine, acetone + octenol, acetone + octenol + cow urine, were evaluated using biconical and NGU traps for their efficacy as a first step in developing a sustainable community-based HAT control initiative. The biconical traps baited with acetone, octenol or cow urine, or when combined, were more effective in catching G. m. submorsitans than the NGU traps (P < 0.05). However, the NGU traps caught more female tsetse flies than the biconical traps (P < 0.05). The acetone, octenol and cow urine combination was the most effective in attracting tsetse flies in both the biconical and NGU traps. Acetone was the best attractant while octenol was the least effective. Cow urine showed great promise for possible use in community-based HAT control activities, especially urine that has been kept for several days. The use of cow urine in HAT control in Ethiopia is likely to succeed in the future because of its sustainability.