Ageing of a rural Ethiopian population: who are the survivors?

OBJECTIVES

This study assessed trends in survival to old age and identified the factors associated with longevity among the elderly (age > or = 65 years).

STUDY DESIGN

Cohort analysis of demographic surveillance data.

METHODS

The study was conducted in the Butajira Rural Health Programme Demographic Surveillance Site in Ethiopia. Using data collected between 1987 and 2004, the probability of survival to 65 years and remaining life expectancy for women and men aged 65 years were computed. Cox regression analysis was used to assess survival by different factors.

RESULTS

Although the elderly represented 3% of the population, their person-time contribution increased by 48% over the 18-year period. Less than half reached 65 years of age, with remaining life expectancy at 65 years ranging from 15 years in rural men to 19 years in urban women. Rural residence, illiteracy and widowhood were associated with lower survival adjusted for other factors, whereas gender did not show a significant difference. However, the effect of these factors differed between men and women, as demonstrated by survival curves and Cox regression. Widowhood [hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.59-2.57] and illiteracy (HR 2.26, 95% CI 1.86-2.73) affected males to a greater extent than females, and rural residence was associated with poorer female survival (HR 1.68, 95% CI 1.55-1.83).

CONCLUSIONS

The number of elderly people is increasing in Ethiopia, with the chance of survival into older age being similar between men and women and approaching that in developed countries. However, rural women and illiterate women and men, particularly widowers, are disadvantaged in terms of survival.

Obstetric fistula in rural Ethiopia

OBJECTIVES

To determine the prevalence of obstetric fistula in rural Ethiopia and identify the circumstances and barriers to care that enhance development of obstetric fistula and its health and social consequences.

DESIGN

A cross-sectional study.

SETTING

The study was conducted in seven out of eleven administrative regions of Ethiopia by visiting randomly selected houses in rural areas and identifying women who have or had obstetric fistula and interviewing them.

RESULTS

A total of 19,153 houses were visited. Untreated fistula prevalence was about 1.5 per 1000 amounting to approximately 26,819 women. Most of the patients were young women who delivered for the first time. Marriage took place early in life mostly through family arrangements or abduction. The median number of days in labour was three to eight.

CONCLUSION

Promotive measures such as increasing age at marriage, and identification and treatment of patients should be intensified. There is a great need in improving accessibility and affordability of basic and emergency obstetric services for rural communities. Curving the situation in the long run requires dealing with the problem of poverty and improvement in the status of women.

Occupational environment as perceived by workers at a textile mill in Bahir Dar, northwest Ethiopia

This cross sectional study was conducted among textile mill workers in Bahir Dar town in 1995/96. The main objective of the study was to investigate how workers perceive their work environment and explore their state of satisfaction with their work. A pretested questionnaire was administered by trained health workers to 394 production workers. The majority of the workers (53.6%) claimed the work environment to be hot. For 66.8%, the physical conditions around the working departments was worst during the hot season. The work place was perceived as dusty and noisy by 47.2% and 36.0% of the respondents respectively. The distribution of adverse environmental complaint by work department was not the same. A higher proportion of the workers in the spinning department complained of inadequate air movement (64.5%) and dusty work place (53.3%); whereas those in the weaving department complained the work place to be hot and noisy (60.5%, 53.5% respectively). Aprons were used by 95.7%, but other personal protectors such as ear protectors, gloves and goggles were used rarely. In general, 228 (57.9%) workers were satisfied but the rest were dissatisfied with their work environment. In order to improve the hygienic conditions in the work place, 71.2% suggested use of different kinds of personal protectors. In conclusion, personal protectors should always be used, environmental hygiene should be conducted and health education should be provided to workers.

Shift work and sleep disorder among textile mill workers in Bahir Dar, northwest Ethiopia

OBJECTIVE

To assess the length and quality of sleep among shift workers at Bahir Dar textile mill.

DESIGN

A cross sectional study using structured questionnaire that contained sociodemographic variables, duration of work, work schedule, number of sleeping hours, sleep disorders, and associated reasons for such disorders.

SETTING

A textile mill in Bahir Dar, northwest Ethiopia.

SUBJECTS

Three-hundred ninety four random sample of production workers of the mill.

OUTCOME MEASURES

Sleep disorders, and the impact of external and home environment on sleep.

RESULTS

The mean duration of work in the factory was 25.4 +/- 7.1 years. Ninety-seven per cent of the study population work in a rotating eight hourly shift system. The mean number of hours a worker sleeps after a worked shift was 5.1 +/- 2.3. Two hundred thirty (58.4%) claimed to experience a sleep disorder. Sleep disturbance was significantly associated with rotating shift work, external environmental noise, and working in the spinning department.

CONCLUSION

The majority of the workers in Bahir Dar textile mill experienced sleep disturbances as detailed in the study methodology.

Patterns of childhood mortality in three districts of north Gondar Administrative Zone. A community based study using the verbal autopsy method

This community based study was undertaken to determine the infant and child mortality rates, causes of childhood mortality and examine the utilization patterns of health services in north Gondar Administrative Zone. The study was conducted from November 1994 to May 1995. A pretested questionnaire based on criteria suggested for diagnosis of childhood mortality in developing countries, using verbal autopsy, was administered to mothers or care takers whose under five children died within five years prior to data collection. A total of 5,001 households were visited and 428 deaths were identified. Infant and child mortality rates were estimated as 103 per 1000 live births and 41 per 1000 children respectively. The most common causes of mortality were respiratory tract infections, diarrhoea and malnutrition. The method of verbal autopsy if used with well tested and validated criteria may be of great help in describing mortality patterns in places where there is no regular surveillance of mortality. Based on the results, intervention packages on the most common causes of mortality at different levels of health care can be devised.

Assessment of rational drug use and prescribing in primary health care facilities in north west Ethiopia

A study on rational drug use was undertaken in nine health centres (HCs) and nine health stations (HSs) in Ethiopia. Prescribing, patient care and facility specific factors were measured using drug use indicators. Prescribing patterns of drugs were also assessed. With only few exceptions, the drug use indicators in HCs and HSs and between retrospective and prospective studies were similar despite differences in manpower and facilities. The average consultation time (in minutes) in HSs and HCs was 5.1 +/- 0.8 and 5.8 +/- 1.06, respectively. The dispensing time (in minutes) was 1.5 +/- 0.7 in HSs and 1.9 +/- 0.6 in HCs. Both patient care indicators seem to be adequate to influence patient satisfaction to the overall health service and patient knowledge of important dosage instructions. Most drugs (more than 89% in HCs and 71% in HSs) were actually dispensed from the health facilities and labelling was satisfactory. Prescribing by generic names (average: 75% in HCs and 83% in HSs) was encouraging. While the availability of key drugs was ensured, essential documents were missing in most facilities or they were unpopular for use, and those available required revision and updating. Polypharmacy in which the number of drugs/encounter was < 2.5 was minimal, but that a large proportion of the prescriptions contained two or more drugs could result in adverse drug-drug interactions. The most frequently prescribed drugs were anti-infectives and analgesics accounting for over 76% in HCs and 82% in HSs and in most cases they are probably prescribed with little justification. The exposure of patients to antibiotics (average: 60% in HCs and 65% in HSs) was unacceptably high to justify epidemiological trends. The high exposure of patients to injections, especially in the HSs (over 37%), should be seen from the health and economic points of view. The results revealed priority areas for intervention. They also provide standard references to compare drug use situations and their change over time in different settings, area and time in Ethiopia.

Sexual behaviour, and knowledge and attitude towards HIV/AIDS among out of school youth in Bahir Dar Town, northwest Ethiopia

Intervention to control the spread of HIV/AIDS in out of school youth is under way in Bahir Dar Town. This survey was therefore conducted in April 1994 to provide baseline data on sexual behaviour, knowledge and attitude towards HIV/AIDS. A total of 1115 out of school young people from eight randomly selected kebeles of the town were interviewed. Fifty one (4.6%) respondents said they have never heard of AIDS. Mean number of sexual partners for those who practised sex was 3.9 +/- 2.5. Knowledge scores were better than attitude and practice scores. Age, sex, marital status, educational status and occupation were significantly related with knowledge, attitude and practice scores (p < 0.05). The association of knowledge scores with attitude and practice scores was not statistically significant; p = 0.056 and p = 0.07, respectively. In addition to improving knowledge, emphasis should be given to other measures such as making the services accessible to the youth. A similar survey is recommended after the intervention programme is over.

Seroprevalence of syphilis amongst pregnant women attending antenatal clinics in a rural hospital in north west Ethiopia

OBJECTIVE

To determine the seroprevalence of syphilis in pregnant women attending antenatal care clinics in a rural hospital in Ethiopia and describe their characteristics so that timely and effective care can be offered.

SUBJECTS

Pregnant women attending antenatal care clinics at a rural hospital.

METHODS

A cross sectional study was conducted at a rural hospital in north west Ethiopia in September 1994. Data were collected on socio demographic characteristics and past history of sexually transmitted diseases of antenatal care attenders from the records of the hospital. Sera from these pregnant women were examined for syphilis using the VDRL test. VDRL positivity was cross tabulated with socio demographic variables and past history of sexually transmitted diseases.

RESULTS

Two hundred and seventy pregnant women were included in the study. Median age of the respondents was 25.2 years. A substantial majority were orthodox Christians (97.4%) and married (92.6%). Town dwellers constituted 58.2% of the antenatal care attenders. Only 4.7% of the women started attending antenatal care clinics during the first trimester. Thirty seven women (13.7%) were found to be VDRL positive. Past history of sexually transmitted diseases was significantly associated with VDRL positivity (p < 0.05).

CONCLUSIONS

High VDRL positivity rate is observed in this study. Certain risk factors may be responsible for current and past episodes of sexually transmitted diseases. There is a need for improvement of antenatal care activities at different levels of health care. Appropriate strategies should be devised for prevention and control of sexually transmitted diseases in women of reproductive age groups and the general population.

Seroprevalence of human immunodeficiency virus infection and its association with syphilis seropositivity among antenatal clinic attenders at Debretabor Rural Hospital, Ethiopia

Sera collected for syphilis screening from pregnant women attending antenatal clinic at Debretabor rural hospital, north west Ethiopia were tested for HIV infection with the objective of assessing HIV prevalence and the relationship between syphilis and human immunodeficiency virus (HIV) seropositivity. A total of 270 pregnant women who visited antenatal clinics from June to September, 1994 were included in the study. Socio-demographic characteristics of the women were retrieved from antenatal care cards. Sera were screened for syphilis and HIV infection by VDRL and ELISA tests respectively. Twenty nine pregnant women (10.7%) were found to be HIV positive. Those living in other villages and rural towns appeared to have a low risk (odds ratio 0.3, 95% confidence interval 0.1-0.8) of acquiring HIV infection when compared to those living in Debretabor town. Women who were seropositive for syphilis were twice as likely to be positive for HIV. Prevention of HIV transmission to women and infants is a priority health and social concern. Prevention and early recognition and treatment of syphilis and other sexually transmitted diseases (STDs) will be important factors in the prevention and control of HIV transmission.

Factors related to antenatal clinic choice and reported activities of antenatal care clinics by pregnant women in Gulele district, Addis Abeba

Two-hundred-seventy pregnant women in the third trimester in 24 kebeles of Gulele district, Addis Abeba were included in the study to assess the factors associated with the choice of antenatal care (ANC) clinics and the women's views concerning activities at antenatal care clinics. Questionnaire were administered to pregnant women at their homes by trained assistants. Majority of the respondents attended ANC in a health station and the most frequent reason for choice of place of attendance was closeness of health institution to which the pregnant woman lives followed by little or no expenses for antenatal care. One fourth of the women attending antenatal care said that health education is never given at the health institution where they attend antenatal care. About 80% of the attendants reported that their blood pressure was always taken. Blood examinations were said to have been performed for 85.6% of the attendants and 74.1% said their urine was checked. We recommend that activities of ANC clinics be assessed thoroughly by different methods and well designed studies addressing the effect of ANC attendance on pregnancy outcome. Refresher courses for health workers on health education and maternal and child health are suggested.

Knowledge, attitude and practice of family planning among senior high school students in north Gonder

Sexual experience, knowledge, attitude and practice on contraception was studied among 991 senior high school students in north Gonder in May 1993 using anonymous questionnaire. Three-hundred-four students (30.7%) answered that they had experienced sexual intercourse. Out of 83 sexually active female students 25(30.1%) reported to have been pregnant. Only four students admitted to have had abortion. Seven-hundred-fifty (75.7%) students claimed that they know at least one method of modern contraception. Of the variables considered in the study reported knowledge of pills and positive attitude to contraception were significantly associated with modern contraceptive use. The most common reason for not using modern contraceptive methods among sexually active respondents was little or no knowledge of contraceptives followed by no access to contraceptives and harmful effects of contraceptives. It is recommended that family life education should be conducted in high schools. Counselling and clinical services on family planning in high schools and places where adolescents gather for recreation and other purposes may also be considered.