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Shure W, Tayachew A, Berkessa T, Teka G, Biru M, Gebeyehu A, Woldeab A, Tadesse M, Gonta M, Agune A, Hailemariam A, Haile B, Addis B, Moges M, Lisanwork L, Gizachew L, Tigabu E, Mekuria Z, Yimer G, Dereje N, Aliy J, Lulseged S, Melaku Z, Abate E, Gebreyes W, Wossen M, Abayneh A. SARS-CoV-2 co-detection with influenza and human respiratory syncytial virus in Ethiopia: Findings from the severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance, January 01, 2021, to June 30, 2022. PLOS Glob Public Health 2024; 4:e0003093. [PMID: 38635749 PMCID: PMC11025837 DOI: 10.1371/journal.pgph.0003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients' data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1-35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4-10.0) patients, and 64 (1.3%, 95% CI: 1.0-1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15-3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07-0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI.
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Affiliation(s)
- Wolde Shure
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adamu Tayachew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Gizaw Teka
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mengistu Biru
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ayele Gebeyehu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adane Woldeab
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Musse Tadesse
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melaku Gonta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Admikew Agune
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Bizuwork Haile
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Beza Addis
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Muluken Moges
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Leuel Lisanwork
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Lehageru Gizachew
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Eyasu Tigabu
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Zelalem Mekuria
- The Ohio State University Global One Health initiative (GOHi), Columbus, OH, Unites States of America
| | - Getnet Yimer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, Unites States of America
| | | | - Jemal Aliy
- ICAP at Columbia University, Addis Ababa, Ethiopia
| | | | | | - Ebba Abate
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Wondwossen Gebreyes
- The Ohio State University Global One Health initiative (GOHi), Columbus, OH, Unites States of America
- Department of Veterinary Preventive Medicine, Infectious Diseases, The Ohio State University, Columbus, OH, Unites States of America
| | - Mesfin Wossen
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Logan NZ, Kilmarx PH, Rolle I, Patel HK, Duong YT, Lee K, Shang JD, Bodika S, Koui IT, Balachandra S, Li M, Brown K, Nuwagaba-Biribonwoha H, Getaneh Y, Lulseged S, Haile A, West CA, Mengistu Y, McCracken SD, Kalua T, Jahn A, Kim E, Wadonda-Kabondo N, Jonnalagadda S, Hamunime N, Williams DB, McOllogi Juma J, Mgomella GS, Mdodo R, Kirungi WL, Mugisha V, Ndongmo CB, Nkwemu KC, Mugurungi O, Rogers JH, Saito S, Stupp P, Justman JE, Voetsch AC, Parekh BS. Brief Report: Self-Reported HIV-Positive Status but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment Survey Participants-11 Sub-Saharan African Countries, 2015-2018. J Acquir Immune Defic Syndr 2024; 95:313-317. [PMID: 38412045 DOI: 10.1097/qai.0000000000003363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/05/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018. METHOD Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate. RESULTS Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection. CONCLUSIONS A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.
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Affiliation(s)
- Naeemah Z Logan
- Epidemic Intelligence Service, CDC, Atlanta, GA
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Peter H Kilmarx
- Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Italia Rolle
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Kiwon Lee
- ICAP-Columbia University, New York, NY
| | - Judith D Shang
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Stephane Bodika
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Shirish Balachandra
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Michelle Li
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Yimam Getaneh
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ashenafi Haile
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Christine A West
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Yohannes Mengistu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - Andreas Jahn
- Department for HIV and AIDS, Ministry of Health and Population, Lilongwe, Malawi
- I-TECH, Department of Global Health, University of Washington, Seattle, WA
| | - Evelyn Kim
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Sasi Jonnalagadda
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - James McOllogi Juma
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Tanzania National AIDS Control Program, Dodoma, Tanzania
| | - George S Mgomella
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Rennatus Mdodo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - Clement B Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Paul Stupp
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Bharat S Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
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Frantzis I, Levasseur S, Huebner J, Mahida M, Larussa P, James W, Abebe W, Ngwenya C, Mupere E, Rosenthal SL, Patterson J, Johnson J, Strehlau R, Lulseged S, Stanberry LR, Saiman L. Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS). Int J Hyg Environ Health 2024; 259:114357. [PMID: 38564877 DOI: 10.1016/j.ijheh.2024.114357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. METHODS We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. RESULTS We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DISCUSSION This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.
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Affiliation(s)
- Irene Frantzis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
| | - Stéphanie Levasseur
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jack Huebner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maitry Mahida
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Larussa
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wilmot James
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Workeabeba Abebe
- Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crispen Ngwenya
- Paediatrics department at Midlands State University faculty of Medicine, Gweru, Zimbabwe
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Janna Patterson
- Global Child Health and Life Support, American Academia of Pediatrics, Itasca, IL, USA
| | - Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sileshi Lulseged
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Abbaba, Ethiopia
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Eskinder B, Habte D, Molla M, Hailemeskel F, Tewldebirhan E, Kebede T, Assefa T, Kabtyimer D, Amidino W, Lulseged S. Use of Electronic Quality Monitoring Tool and Central Dashboard to Improve Clinical and Programmatic Decisions. Stud Health Technol Inform 2024; 310:1472-1473. [PMID: 38269702 DOI: 10.3233/shti231250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The HIV service quality improvement tool is deployed in 123 health facilities in Ethiopia. The tool uses a central dashboard for visualization and decision making at the health facility and higher levels of the health systems. The dashboard is developed on excel with analytics about HIV testing, case finding, treatment linkage and quality indicators. The dashboard was developed based on the requirements requested during discussions with HIV clinicians and the program team.
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Affiliation(s)
- Biniyam Eskinder
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | | | - Masresha Molla
- Addis Ababa City Administration Health Bureau (AACAHB), Addis Ababa, Ethiopia, USA
| | | | | | - Tekeste Kebede
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | | | - Daniel Kabtyimer
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
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Petros A, Desalegn DM, Dessie GF, Mumme BA, Abebe K, Haile DM, Bogale HB, Mohammed MS, Tesfaye Y, Tedla Y, Gutta GA, Bekedami DL, Melaku Z, Habte D, Lulseged S. Data-Exchange Between Electronic Medical Record and Viral-Load Laboratory Database Towards Improving HIV Care in Ethiopia. Stud Health Technol Inform 2024; 310:1366-1367. [PMID: 38270046 DOI: 10.3233/shti231197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Electronic viral load (VL) Test Ordering and Result Reporting System (ETORRS) was introduced to create data exchange between the existing VL database and the electronic medical record (EMR) system, with the aim of reducing laboratory test results turnaround time (TAT), improving data quality, and supporting timely clinical response for patients with high VL. This use case is an illustrative example of initiating and adopting the principles of health information exchange for a priority health program.
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Affiliation(s)
- Asaminew Petros
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Yohannes Tesfaye
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Yared Tedla
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | | | | | | | - Dereje Habte
- U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
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Rameto MA, Abdella S, Ayalew J, Tessema M, Bulti J, Bati F, Lulseged S. Prevalence and factors associated with inconsistent condom use among female sex workers in Ethiopia: findings from the national biobehavioral survey, 2020. BMC Public Health 2023; 23:2407. [PMID: 38049776 PMCID: PMC10694951 DOI: 10.1186/s12889-023-17253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/17/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor in HIV transmission in the community. However, it has long been known that using condoms correctly and consistently is an extremely cost-effective global method for preventing HIV infection, but inconsistent condom use (ICU) would pose the greatest proximal risk of HIV acquisition and transmission. Understanding the prevalence and associated risk factors of inconsistence condom use among FSWs would inform policymakers to design programmatic interventions in the context of Ethiopia. METHODS This analysis used data from the 'National HIV and STIs Bio-behavioral Survey (NHSBS)', which was conducted between December 2019 up to May 2020 by using a respondent-driven sampling (RDS) technique among FSWs aged 15 years and older who were selling sex in selected major cities and towns in Ethiopia. A multi-level logistic regression model was fitted to assess town and individual-level variations simultaneously to adjust hierarchical variations. Statistical significance was determined by using a P-value less than 0.05 with a 95% confidence interval (CI) not including one. RESULTS Overall, 6,085 FSWs from 16 cities and towns participated in the study. The prevalence of inconsistent condom use across the 16 cities and towns was 17.1% [95% CI (16.5, 17.8)]. Inconsistent condom use was significantly higher among FSWs who had depression compared to those without depression [AOR = 1.43; 95% CI (1.13,1.82)], used any drug [AOR = 1.43; 95% CI (1.14-1.79)], had history of sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], changed sex selling location [AOR = 1.27; 95% CI (1.06, 1.51)], longer period of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], ever had anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], had ≥ 2 non-paying sexual partner [AOR = 2.99; 95% CI(2.26, 3.95)], selling sex `in more than two cities [AOR = 3.01;95% CI (2.27, 3.99)], who lacked access to condom [AOR = 2.1; 95% CI (1.69, 2.67)], and did not have HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)]. CONCLUSION Inconsistent condom use among FSWs is prevalent in Ethiopia and is associated with marital status, education status, depression, alcohol drinking, drug use, sexual violence, being raped, lack of knowledge about HIV, practising anal sex, selling sex in different locations, having more than two non-paying sexual partners, working in more than two cities, and lack of access to condom at the workplace. Programme interventions to enhance consistent condoms use among FSWs need to take these factors into consideration.
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Affiliation(s)
| | - Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jemal Ayalew
- Departments of Statistics, College of Natural Science, Wollo University, Dese, Ethiopia
| | | | - Jaleta Bulti
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fayiso Bati
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Solmo C, Yuengling KA, Cooney ML, Sachathep K, Ayton S, Phillip N, Greenleaf A, Gummerson E, Hennesy N, Lulseged S, Habte D, Kagashe M, Rogers JH, Kirungi W, Battey K, Pasipamire M, Namukanja P, Ndongmo C, Bodika S, Low A. Contraception and intersection with HIV services in 11 high HIV burden sub-Saharan African countries: Results from the population-based HIV Impact Assessment cross-sectional studies conducted from 2015 to 2018. Int J Gynaecol Obstet 2023; 163:875-887. [PMID: 37392010 PMCID: PMC11009789 DOI: 10.1002/ijgo.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The United Nations' Sustainable Development Goal 3.7.1 addresses the importance of family planning. The objective of this paper is to provide information on family planning to policymakers to help increase access to contraceptive methods to women in sub-Saharan Africa. METHODS We analyzed data from the Population-based HIV Impact Assessment studies conducted in 11 sub-Saharan African countries from 2015 to 2018 to assess the relationship between HIV services and family planning. Analyses were restricted to women aged 15-49 years who reported being sexually active within the past 12 months and had data on contraceptive use. RESULTS Approximately 46.4% of participants reported using any form of contraception; 93.6% of whom used modern contraceptives. Women with a positive HIV status were more likely to use contraceptives (P < 0.0001) than HIV-negative women. Unmet need was higher among women who were confirmed to be HIV-negative in Namibia, Uganda, and Zambia than confirmed to be positive. Women aged 15-19 years used contraception less than 40% of the time. CONCLUSION This analysis highlights crucial gaps in progress among HIV-negative and young women (aged 15-19 years). To provide access to modern contraception for all women, programs and governments need to focus on women who desire but do not have access to these family planning resources.
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Affiliation(s)
- Chelsea Solmo
- ICAP at Columbia University, New York, New York, USA
| | | | | | | | - Sarah Ayton
- Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Neena Phillip
- ICAP at Columbia University, New York, New York, USA
| | | | | | - Nora Hennesy
- Public Health Institute, Dar es Salaam, Tanzania
| | | | - Dereje Habte
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Magreth Kagashe
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dodoma, Tanzania
| | - John H. Rogers
- Center for Global Health, US Centers for Disease Control and Prevention (CDC), President’s Malaria Initiative, Abuja, Nigeria
| | | | - Katherine Battey
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Munyaradzi Pasipamire
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Manzini, Eswatini
| | - Phoebe Namukanja
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Clement Ndongmo
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Yaounde, Cameroon
| | - Stephane Bodika
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Andrea Low
- ICAP at Columbia University, New York, New York, USA
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Bedassa BB, Ebo GG, Yimam JA, Tura JB, Wariso FB, Lulseged S, Eticha GT, Wolde TK, Abrahim SA. Correction: Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020. PLoS One 2023; 18:e0292824. [PMID: 37812626 PMCID: PMC10561828 DOI: 10.1371/journal.pone.0292824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0269510.].
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Wariso FB, Ayalew J, Barba A, Bedassa BB, Ebo GG, Tura JB, Rameto M, Belihu WB, Asfaw D, Amogne MD, Negeri L, Lulseged S, Abrahim SA. Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach. Front Public Health 2023; 11:1190085. [PMID: 37601188 PMCID: PMC10437068 DOI: 10.3389/fpubh.2023.1190085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Background Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia. Methods A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p-value of ≤0.05 was used as a threshold for statistical significance. Results At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs. Conclusion STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis.
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Affiliation(s)
| | - Jemal Ayalew
- College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Ammar Barba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Lemessa Negeri
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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10
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Ajiboye AS, Eshetu F, Lulseged S, Getaneh Y, Tademe N, Kifle T, Bray R, Eshete H, Demissie Y, Dykewicz CA, Hoos D. Predictors of HIV testing among youth 15-24 years in urban Ethiopia, 2017-2018 Ethiopia population-based HIV impact assessment. PLoS One 2023; 18:e0265710. [PMID: 37467301 DOI: 10.1371/journal.pone.0265710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Youth (adolescents and young adults) aged 15-24 years comprise approximately 22% of Ethiopia's total population and make up 0.73% of HIV cases in urban Ethiopia. However, only 63% of HIV-positive youth are aware of their HIV status. We describe the HIV testing behaviors of youth 15-24 years and determined the characteristics of those who were most likely to be tested for HIV within the past year. METHODS Using data from the 2017-2018 Ethiopia Population-based HIV Impact Assessment, we provide survey-weighted estimates and prevalence risk ratios for engagement in HIV testing in the 12 months preceding the survey. We model the likelihood of HIV testing one year or more before the survey compared to never testing, using a multinomial logistic regression model. RESULTS Among HIV-negative and unaware HIV-positive youth 15-24 years old (N = 7,508), 21.8% [95% Confidence Interval (CI): 20.4-23.3%] reported testing for HIV in the last 12 months. Female youth [Prevalence Ratio (PR) = 1.6, 95% CI: 1.4-1.8], those aged 20-24 years (PR = 2.6, 95% CI:2.3-2.9), and those ever married (PR = 2.8, 95% CI: 2.5-3.1) were more likely to have tested for HIV within the last year. Adjusting for select demographic characteristics, sex with a non-spousal or non-live-in partner [Relative Risk (RR) = 0.3, 95% CI:0.1-0.8] among males did not increase their likelihood to test for HIV in the prior 12 months. Female youth engaged in antenatal care (RR = 3.0, 95% CI: 1.7-5.3) were more likely to test for HIV in the past year. CONCLUSION The Ethiopian HIV case finding strategy may consider approaches for reaching untested youth, with a specific focus on adolescent males,15-19 years of age. This is critical towards achieving the UNAIDS HIV testing goal of 95% of all individuals living with HIV aware of their status by 2030.
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Affiliation(s)
- Aderonke S Ajiboye
- Division of Global HIV and TB, Center for Global Health, CDC, Addis Ababa, Ethiopia
| | - Frehywot Eshetu
- Division of Global HIV and TB, Center for Global Health, CDC, Addis Ababa, Ethiopia
| | | | - Yimam Getaneh
- Ethiopia Public Health Institute, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Nadew Tademe
- ICAP at Columbia Universfity, Addis Ababa, Ethiopia
| | - Tsigereda Kifle
- Ethiopia Public Health Institute, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Rachel Bray
- ICAP at Columbia University, New York, New York, United States of America
| | | | | | - Clare A Dykewicz
- Division of Global HIV and TB, Center for Global Health, CDC, Addis Ababa, Ethiopia
| | - David Hoos
- ICAP at Columbia University, New York, New York, United States of America
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11
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Tura JB, Ayalew J, Moreda AB, Lulseged S, Rameto MA, Debel LN, Bedassa BB, Ebo GG, Wariso FB, Belihu WB, Gutema EA, Habteselassie A, Tollera G, Hailu M, Abrahim SA. Prevalence of syphilis and associated factors among female sex workers in Ethiopia: findings from a multilevel analysis of a national bio-behavioral survey. BMC Public Health 2023; 23:809. [PMID: 37138265 PMCID: PMC10155315 DOI: 10.1186/s12889-023-15745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Syphilis is a highly contagious sexually transmitted infection posing a significant public health challenge, especially in developing countries, including sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. However, data on national syphilis prevalence estimates and the associated factors are scarce in Ethiopia. This, as well as our limited knowledge about the extent of clustering among female sex workers in the country, is a critical gap in information we aimed to fill through this analysis. METHODS The study was a cross-sectional, bio-behavioral survey conducted among female sex workers in six cities and ten major towns in Ethiopia. Participants were selected using a respondent-driven sampling method. Survey participants provided blood samples for syphilis, HIV, and hepatitis serological testing. Survey data were collected via an interviewer-administered questionnaire. In this analysis, we employed descriptive statistics to summarize data on the study variables. In addition, we used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the dependent variable (syphilis prevalence) while accounting for the clustering effect. RESULT A total of 6085 female sex workers participated in the survey. Their median age [Interquartile Range (IQR) was 25 (8)] years, and a majority (96.1%) were in the 20-24-year-old age group. The prevalence of syphilis among female sex workers in Ethiopia's six cities and ten major towns was 6.2%. Being in the age group of 30-34 (AOR = 2.64; 95% CI = 1.40, 4.98) and 35-59 (AOR = 4.7; 95% CI = 2.5, 8.86), being divorced/widowed (AOR = 1.37; 95% CI = 1.03, 1.82), having no formal education (AOR = 3.38; 95% CI = 2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR = 2.77; 95% CI = 1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR = 1.80; 95% CI = 1.21, 2.69) were significantly associated with syphilis among female sex workers. CONCLUSION The prevalence of syphilis among female sex workers was high. Being divorced/widowed or in the older age group and having a low level of education were significantly associated with an increased risk of syphilis. The high prevalence and associated factors identified need to be considered in planning comprehensive interventions to control syphilis among female sex workers in Ethiopia.
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Affiliation(s)
| | | | | | - Sileshi Lulseged
- Faculty of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | - Mesay Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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12
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Bedassa BB, Ebo GG, Yimam JA, Tura JB, Wariso FB, Lulseged S, Eticha GT, Wolde TK, Abrahim SA. Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020. PLoS One 2022; 17:e0269510. [PMID: 36584042 PMCID: PMC9803120 DOI: 10.1371/journal.pone.0269510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatitis B and C virus infections are endemic diseases in sub-Saharan Africa, the region with the highest prevalence of these infections in the world. Female sex workers are exposed to sexually transmitted infections, including hepatitis B and C, because of their high-risk sexual behavior and limited access to health services. There are no large-scale data on the prevalence of hepatitis B and C virus infections among female sex workers in Ethiopia, a critical gap in information this study aimed to fill. METHODS This was a cross-sectional, biobehavioral survey conducted from December 2019-April 2020 among 6085 female sex workers aged ≥15 years and residing in sixteen (16) regional capital cities and selected major towns of Ethiopia. Blood samples were collected from the participants for hepatitis B and C virus serological testing. The data were collected using an open data kits (ODK) software and imported into STATA version16 for analysis. Descriptive statistics (frequencies and proportions) were used to summarize data on the study variables. Bivariable and multivariable logistic regression analyses were conducted to determine the strength of association between independent variables (risk factors) and the outcome (hepatitis B and C virus infection). Adjusted Odd ratio (AOR) was used to determine independent associations, 95% confidence interval to assess precision of the estimates, and a P value ≤ 0.05 to determine statistically significant. RESULTS The prevalence of hepatitis B and C infections among the 6085 female sex workers was 2.6% [(95% CI (2.2,2.8)] and 0.5% [(95% CI (0.4,0.7)], respectively. Female sex workers who had 61-90 and ≥91 paying clients in the past six months [(AOR = 1.66; 95% CI, (0.99, 2.79); P = 0.054] and [(AOR = 1.66 95% CI, (1.11, 2.49); P = 0.013], respectively, age at first sex selling of 20-24 and >25 years [(AOR = 1.67; 95% CI, (1.14, 2.44); P = 0.009)] and [(AOR = 1.56; 95% CI (1.004, 2.43); P = 0.048)], respectively, known HIV positive status [(AOR = 1.64; 95% CI (1.03, 2.62); P = 0.036] were significantly associated with the prevalence of hepatitis B virus infection. Similarly, hepatitis C was significantly associated with, age at first sex ≤15 years and age 16-20 years [(AOR = 0.21; 95%CI (0.07,0.61); P = 0.005)] and [(AOR = 0.18; 95% CI (0.061, 0.53); P = 0.002)], respectively, known HIV positive status [(AOR = 2.85; 95%CI (1.10,7.37); P = 0.031)] and testing positive for syphilis [(AOR = 4.38; 95% CI (1.73,11.11); P = 0.002)], respectively. CONCLUSION This analysis reveals an intermediate prevalence of hepatitis B and a low prevalence of hepatitis C infection among female sex workers in Ethiopia. It also suggests that population groups like female sex workers are highly vulnerable to hepatitis B, hepatitis C, and other sexually transmitted infections. There is a need for strengthening treatment and prevention interventions, including immunization services for hepatitis B vaccination, increasing HCV testing, and provision of treatment services.
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Affiliation(s)
| | | | - Jemal Ayalew Yimam
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Statistics, College of Natural Science, Wollo University, Kombolcha, Ethiopia
| | | | | | - Sileshi Lulseged
- Faculty of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Gelibo T, Lulseged S, Eshetu F, Abdella S, Melaku Z, Ajiboye S, Demissie M, Solmo C, Ahmed J, Getaneh Y, Kaydos-Daniels SC, Abate E. Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017–2018). PLoS One 2022; 17:e0271221. [PMID: 35819961 PMCID: PMC9491827 DOI: 10.1371/journal.pone.0271221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
The design and evaluation of national HIV programs often rely on aggregated
national data, which may obscure localized HIV epidemics. In Ethiopia, even
though the national adult HIV prevalence has decreased, little information is
available about local areas and subpopulations. To inform HIV prevention efforts
for specific populations, we identified geographic locations and drivers of HIV
transmission. We used data from adults aged 15–64 years who participated in the
Ethiopian Population-based HIV Impact Assessment survey (October 2017–April
2018). Location-related information for the survey clusters was obtained from
the 2007 Ethiopia population census. Spatial autocorrelation of HIV prevalence
data were analyzed via a Global Moran’s I test. Geographically weighted
regression analysis was used to show the relationship of covariates. The finding
indicated that uncircumcised men in certain hotspot towns and divorced or
widowed individuals in hotspot woredas/towns might have contributed to the
average increase in HIV prevalence in the hotspot areas. Hotspot analysis
findings indicated that, localized, context-specific intervention efforts
tailored to at-risk populations, such as divorced or widowed women or
uncircumcised men, could decrease HIV transmission and prevalence in urban
Ethiopia.
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Affiliation(s)
- Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
- * E-mail:
| | - Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Frehywot Eshetu
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Saro Abdella
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Solape Ajiboye
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Atlanta, GA, United States of
America
| | - Minilik Demissie
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Chelsea Solmo
- ICAP at Columbia University, New York, New York, United States of
America
| | - Jelaludin Ahmed
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Yimam Getaneh
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Susan C. Kaydos-Daniels
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Ebba Abate
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
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Lulseged S, Melaku Z, Habteselassie A, West CA, Gelibo T, Belete W, Tefera F, Farahani M, Demissie M, Teferi W, Abdella S, Birhanu S, Ross CE. Progress towards controlling the HIV epidemic in urban Ethiopia: Findings from the 2017-2018 Ethiopia population-based HIV impact assessment survey. PLoS One 2022; 17:e0264441. [PMID: 35213668 PMCID: PMC8880883 DOI: 10.1371/journal.pone.0264441] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2014, the Joint United Nations Programme on HIV/AIDS set an 'ambitious' 90-90-90 target for 2020. By 2016, there were disparities observed among countries in their progress towards the targets and some believed the targets were not achievable. In this report, we present the results of data from the Ethiopia Population-based HIV Impact Assessment survey analyzed to assess progress with the targets and associated factors. METHODS We conducted a nationally representative survey in urban areas of Ethiopia. Socio-demographic and behavioural data were collected from consenting participants using a structured interview. HIV testing was done following the national HIV rapid testing algorithm and seropositivity confirmed using a supplemental laboratory assay. HIV viral suppression was considered if the viral load was <1,000 RNA copies/ml. Screening antiretroviral drugs was done for efavirenz, lopinavir, and tenofovir, which were in use during the survey period. In this analysis, we generated weighted descriptive statistics and used bivariate and logistic regression analysis to examine for associations. The 95% confidence interval was used to measure the precision of estimates and the significance level set at p<0.05. RESULTS Of 19,136 eligible participants aged 15-64 years, 614 (3% [95% CI: 0.8-3.3]) were HIV-positive, of which 79.0% (95% CI: 4.7-82.7) were aware of their HIV status, and 97.1% (95% CI: 95.0-98.3 were on antiretroviral therapy, of which 87.6% (95% CI: 83.9-90.5) achieved viral load suppression. Awareness about HIV-positive status was significantly higher among females (aOR = 2.8 [95% CI: 1.38-5.51]), significantly increased with age, the odds being highest for those aged 55-64 years (aOR = 11.4 [95% CI: 2.52-51.79]) compared to those 15-24 years, and was significantly higher among those who used condom at last sex in the past 12 months (aOR = 5.1 [95% CI: 1.68-15.25]). Individuals with secondary education and above were more likely to have achieved viral suppression (aOR = 8.2 [95% CI: 1.82-37.07]) compared with those with no education. CONCLUSION Ethiopia made encouraging progress towards the UNAIDS 90-90-90 targets. The country needs to intensify its efforts to achieve the targets. A particular focus is required to fill the gaps in knowledge of HIV-positive status to increase case identification among population groups such as males, the youth, and those with low education.
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Affiliation(s)
- Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Abebe Habteselassie
- Department of HIV and TB, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Christine A. West
- Division of Global HIV and TB, Centre for Global Health, Centres for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Wudinesh Belete
- Department of HIV and TB, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Fana Tefera
- Care and Treatment Branch, United States Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mansoor Farahani
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Minilik Demissie
- Department of HIV and TB, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Wondimu Teferi
- Care and Treatment Branch, United States Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Saro Abdella
- Department of HIV and TB, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Sehin Birhanu
- Division of Global HIV and TB, Centre for Global Health, Centres for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christine E. Ross
- Care and Treatment Branch, United States Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Lulseged S, Belete W, Ahmed J, Gelibo T, Teklie H, West CW, Melaku Z, Demissie M, Farhani M, Eshetu F, Birhanu S, Getaneh Y, Patel H, Voetsch AC. Factors associated with unawareness of HIV-positive status in urban Ethiopia: Evidence from the Ethiopia population-based HIV impact assessment 2017-2018. PLoS One 2021; 16:e0255163. [PMID: 34380145 PMCID: PMC8357455 DOI: 10.1371/journal.pone.0255163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country’s response to the epidemic. Methods We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants’ level of unawareness of their HIV-positive status (adjusted for ARV status). Results We interviewed 20,170 survey participants 15–64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15–24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status. Conclusion One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.
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Affiliation(s)
- Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
- * E-mail:
| | - Wudinesh Belete
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Jelaludin Ahmed
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Christine W. West
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Minilik Demissie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mansoor Farhani
- ICAP. Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Frehywot Eshetu
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sehin Birhanu
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yimam Getaneh
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Hetal Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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West CA, Chang GC, W Currie D, Bray R, Kinchen S, Behel S, McCullough-Sanden R, Low A, Bissek A, Shang JD, Ndongmo CB, Dokubo EK, Balachandra S, Lobognon LR, Dube L, Nuwagaba-Biribonwoha H, Li M, Pasipamire M, Getaneh Y, Lulseged S, Eshetu F, Kingwara L, Zielinski-Gutierrez E, Tlhomola M, Ramphalla P, Kalua T, F Auld A, B Williams D, Remera E, Rwibasira GN, Mugisha V, Malamba SS, Mushi J, Jalloh MF, Mgomella GS, Kirungi WL, Biraro S, C Awor A, Barradas DT, Mugurungi O, H Rogers J, Bronson M, M Bodika S, Ajiboye A, Gaffga N, Moore C, Patel HK, C Voetsch A. Unawareness of HIV Infection Among Men Aged 15-59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015-2019. J Acquir Immune Defic Syndr 2021; 87:S97-S106. [PMID: 34166316 PMCID: PMC8711576 DOI: 10.1097/qai.0000000000002708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.
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Affiliation(s)
| | - Gregory C Chang
- Division of Global HIV and TB, Center for Global Health, CDC
- ASPPH/PHI/CDC HIV Surveillance Fellowship
| | - Dustin W Currie
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | - Steve Kinchen
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Rachel McCullough-Sanden
- ASPPH/PHI/CDC HIV Surveillance Fellowship
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Andrea Low
- ICAP at Columbia University, New York, NY
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | - Judith D Shang
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Clement B Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
- Division of Global HIV and TB, Center for Global Health, CDC Zambia
| | - Emily K Dokubo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | | | - Legre R Lobognon
- Division of Global HIV and TB, Center for Global Health, CDC Cote d'Ivoire
| | - Lenhle Dube
- National AIDS Program/Ministry of Health, Eswatini
| | | | - Michelle Li
- Division of Global HIV and TB, Center for Global Health, CDC Eswatini
| | | | | | | | - Frehywot Eshetu
- Division of Global HIV and TB, Center for Global Health, CDC Ethiopia
| | - Leonard Kingwara
- National AIDS and STI Control Programme, Ministry of Health, Kenya
| | | | | | - Puleng Ramphalla
- Division of Global HIV and TB, Center for Global Health, CDC Lesotho
| | | | - Andrew F Auld
- Division of Global HIV and TB, Center for Global Health, CDC Malawi
| | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC Namibia
| | | | | | - Veronicah Mugisha
- ICAP at Columbia University, Rwanda
- ICAP at Columbia University, Tanzania
| | - Samuel S Malamba
- Division of Global HIV and TB, Center for Global Health, CDC Rwanda
| | - Jeremiah Mushi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania
| | - Mohamed F Jalloh
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | - George S Mgomella
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | | | | | - Anna C Awor
- Division of Global HIV and TB, Center for Global Health, CDC Uganda
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC Zimbabwe
| | - Megan Bronson
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | | | - Nicholas Gaffga
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Carole Moore
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, CDC
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Melaku Z, Lulseged S, Wang C, Lamb MR, Gutema Y, Teasdale CA, Ahmed S, Gadisa T, Habtamu Z, Bedri A, Fayorsey R, Abrams EJ. Outcomes among HIV-infected children initiating HIV care and antiretroviral treatment in Ethiopia. Trop Med Int Health 2017; 22:474-484. [PMID: 28066962 DOI: 10.1111/tmi.12834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe pediatric ART scale-up in Ethiopia, one of the 21 global priority countries for elimination of pediatric HIV infection. METHODS A descriptive analysis of routinely collected HIV care and treatment data on HIV-infected children (<15 years) enrolled at 70 health facilities in four regions in Ethiopia, January 2006-September 2013. Characteristics at enrollment and ART initiation are described along with outcomes at 1 year after enrollment. Among children who initiated ART, cumulative incidence of death and loss to follow-up (LTF) were estimated using survival analysis. RESULTS 11 695 children 0-14 years were enrolled in HIV care and 6815 (58.3%) initiated ART. At enrollment, 31.2% were WHO stage III and 6.3% stage IV. The majority (87.9%) were enrolled in secondary or tertiary facilities. At 1 year after enrollment, 17.9% of children were LTF prior to ART initiation. Among children initiating ART, cumulative incidence of death was 3.4%, 4.1% and 4.8%, and cumulative incidence of LTF was 7.7%, 11.8% and 16.6% at 6, 12 and 24 months, respectively. Children <2 years had higher risk of LTF and death than older children (P < 0.0001). Children with more advanced disease and those enrolled in rural settings were more likely to die. Children enrolled in more recent years were less likely to die but more likely to be LTF. CONCLUSIONS Over the last decade large numbers of HIV-infected children have been successfully enrolled in HIV care and initiated on ART in Ethiopia. Retention prior to and after ART initiation remains a major challenge.
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Affiliation(s)
| | | | - Chunhui Wang
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew R Lamb
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Chloe A Teasdale
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Solomon Ahmed
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | - Abubaker Bedri
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ruby Fayorsey
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elaine J Abrams
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Lulseged S. BREAKS IN REPORTING OF RESEARCH RESULTS: WHERE DO WE GO FROM HERE? Ethiop Med J 2017; 55:1-2. [PMID: 29148632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Ayele W, Lulseged S. FEMALE GENITAL MUTILATION AS AN ISSUE OF GENDER DISPARITY IN THE 21ST CENTURY: LEVERAGING OPPORTUNITIES TO REVERSE CURRENT TRENDS. Ethiop Med J 2016; 54:107. [PMID: 29115776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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20
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Lulseged S. IMPROVING QUALITY OF THE ETHIOPIAN MEDICAL JOURNAL: CURRENT CHALLENGES TO CHANGING THE TIDE. Ethiop Med J 2016; 54:2 p preceding table of contents. [PMID: 27191023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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21
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Alemayehu G, Melaku Z, Abreha T, Alemayehu B, Girma S, Tadesse Y, Gadisa T, Lulseged S, Balcha TT, Hoos D, Teka H, Reithinger R. Burden of malaria among adult patients attending general medical outpatient department and HIV care and treatment clinics in Oromia, Ethiopia: a comparative cross-sectional study. Malar J 2015; 14:501. [PMID: 26671012 PMCID: PMC4681039 DOI: 10.1186/s12936-015-1029-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background Malaria and HIV/AIDS constitute major public health problems in Ethiopia, but the burden associated with malaria-HIV co-infection has not been well documented. In this study, the burden of malaria among HIV positive and HIV negative adult outpatients attending health facilities in Oromia National Regional State, Ethiopia was investigated. Methods A comparative cross-sectional study among HIV-positive patients having routine follow-up visits at HIV care and treatment clinics and HIV-seronegative patients attending the general medical outpatient departments in 12 health facilities during the peak malaria transmission season was conducted from September to November, 2011. A total of 3638 patients (1819 from each group) were enrolled in the study. Provider initiated testing and counseling of HIV was performed for 1831 medical outpatients out of whom 1819 were negative and enrolled into the study. Malaria blood microscopy and hemoglobin testing were performed for all 3638 patients. Data was analyzed using descriptive statistics, Chi square test and multivariate logistic regression. Results Of the 3638 patients enrolled in the study, malaria parasitaemia was detected in 156 (4.3 %); malaria parasitaemia prevalence was 0.7 % (13/1819) among HIV-seropositive patients and 7.9 % (143/1819) among HIV-seronegative patients. Among HIV-seropositive individuals 65.4 % slept under a mosquito bed net the night before data collection, compared to 59.4 % of HIV-seronegative individuals. A significantly higher proportion of HIV-seropositive malaria-negative patients were on co-trimoxazole (CTX) prophylaxis as compared to HIV-malaria co-infected patients: 82 % (1481/1806) versus 46 % (6/13) (P = 0.001). HIV and malaria co-infected patients were less likely to have the classical symptoms of malaria (fever, chills and headache) compared to the HIV-seronegative and malaria positive counterparts. Multivariate logistic regression showed that HIV-seropositive patients who come for routine follow up were less likely to be infected by malaria (OR = 0.23, 95 % CI = 0.09–0.74). Conclusion The study documented lower malaria prevalence among the HIV-seropositive attendants who come for routine follow up. Clinical symptoms of malaria were more pronounced among HIV-seronegative than HIV-seropositive patients. This study also re-affirmed the importance of co-trimoxazole in preventing malaria symptoms and parasitaemia among HIV- positive patients.
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Affiliation(s)
- Guda Alemayehu
- U.S. Agency for International Development (USAID), Addis Ababa, Ethiopia.
| | | | | | | | - Samuel Girma
- Columbia University ICAP, Addis Ababa, Ethiopia.
| | | | | | | | - Taye Tolera Balcha
- Oromia Regional Health Bureau and Federal Ministry of Health Addis Ababa, Addis Ababa, Ethiopia.
| | - David Hoos
- Columbia University ICAP, New York, USA.
| | - Hiwot Teka
- U.S. Agency for International Development (USAID), Addis Ababa, Ethiopia.
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Melaku Z, Lamb MR, Wang C, Lulseged S, Gadisa T, Ahmed S, Habtamu Z, Alemu H, Assefa T, Abrams EJ. Characteristics and outcomes of adult Ethiopian patients enrolled in HIV care and treatment: a multi-clinic observational study. BMC Public Health 2015; 15:462. [PMID: 25934178 PMCID: PMC4455051 DOI: 10.1186/s12889-015-1776-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/22/2015] [Indexed: 11/26/2022] Open
Abstract
Background We describe trends in characteristics and outcomes among adults initiating HIV care and treatment in Ethiopia from 2006-2011. Methods We conducted a retrospective longitudinal analysis of HIV-positive adults (≥15 years) enrolling at 56 Ethiopian health facilities from 2006–2011. We investigated trends over time in the proportion enrolling through provider-initiated counseling and testing (PITC), baseline CD4+ cell counts and WHO stage. Additionally, we assessed outcomes (recorded death, loss to follow-up (LTF), transfer, and total attrition (recorded death plus LTF)) before and after ART initiation. Kaplan-Meier techniques estimated cumulative incidence of these outcomes through 36 months after ART initiation. Factors associated with LTF and death after ART initiation were estimated using Hazard Ratios accounting for within-clinic correlation. Results 93,418 adults enrolled into HIV care; 53,300 (57%) initiated ART. The proportion enrolled through PITC increased from 27.6% (2006–2007) to 44.8% (2010–2011) (p < .0001). Concurrently, median enrollment CD4+ cell count increased from 158 to 208 cells/mm3 (p < .0001), and patients initiating ART with advanced WHO stage decreased from 56.6% (stage III) and 15.0% (IV) in 2006–2007 to 47.6% (stage III) and 8.5% (IV) in 2010–2011. Median CD4+ cell count at ART initiation remained stable over time. 24% of patients were LTF before ART initiation. Among those initiating ART, attrition was 30% after 36 months, with most occurring within the first 6 months. Recorded death after ART initiation was 6.4% and 9.2% at 6 and 36 months, respectively, and decreased over time. Younger age, male gender, never being married, no formal education, low CD4+ cell count, and advanced WHO stage were associated with increased LTF. Recorded death was lower among younger adults, females, married individuals, those with higher CD4+ cell counts and lower WHO stage at ART initiation. Conclusions Over time, enrollment in HIV care through outpatient PITC increased and patients enrolled into HIV care at earlier disease stages across all HIV testing points. However, median CD4+ cell count at ART initiation remained steady. Pre- and post-ART attrition (particularly in the first 6 months) have remained major challenges in ensuring prompt ART initiation and retention on ART.
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Affiliation(s)
- Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
| | - Matthew R Lamb
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Chunhui Wang
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
| | - Sileshi Lulseged
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
| | - Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
| | - Solomon Ahmed
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia.
| | | | | | - Tamrat Assefa
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
| | - Elaine J Abrams
- ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, 13th floor, New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. .,College of Physicians & Surgeons, Columbia University, New York, NY, USA.
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Derbew M, Lulseged S, Mariam D. Collaborations between MEPI and NEPI at addis ababa university. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Persaud D, Bedri A, Ziemniak C, Moorthy A, Gudetta B, Abashawl A, Mengistu Y, Omer SB, Isehak A, Kumbi S, Adamu R, Lulseged S, Ashworth R, Hassen E, Ruff, and the Ethiopian SWEN Study A. Slower clearance of nevirapine resistant virus in infants failing extended nevirapine prophylaxis for prevention of mother-to-child HIV transmission. AIDS Res Hum Retroviruses 2011; 27:823-9. [PMID: 21241214 DOI: 10.1089/aid.2010.0346] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nevirapine resistance mutations arise commonly following single or extended-dose nevirapine (ED-NVP) prophylaxis to prevent mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), but decay within 6-12 months of single-dose exposure. Use of ED-NVP prophylaxis in infants is expected to rise, but data on decay of nevirapine resistance mutations in infants in whom ED-NVP failed remain limited. We assessed, in Ethiopian infants participating in the Six-Week Extended Nevirapine (SWEN) Trial, the prevalence and persistence of nevirapine resistance mutations at 6 and 12 months following single-dose or up to 6 weeks of ED-NVP, and correlated their presence with the timing of infection and the type of resistance mutations. Standard population genotyping followed by high-throughput cloning were done on dried blood spot samples collected during the trial. More infants who received ED-NVP had nevirapine resistance detected by standard population genotyping (high frequencies) at age 6 months compared with those who received single-dose nevirapine (SD-NVP) (58% of 24 vs. 26% of 19, respectively; p = 0.06). Moreover, 56% of ED-NVP-exposed infants with nevirapine resistance at age 6 months still had nevirapine resistance mutations present at high frequencies at age 1 year. Infants infected before 6 weeks of age who received either SD- or ED-NVP were more likely to have Y181C or K103N; these mutations were also more likely to persist at high frequencies through 1 year of age. HIV-infected infants in whom ED-NVP prophylaxis fails are likely to experience delayed clearance of nevirapine-resistant virus in the first year of life, which in turn places them at risk for early selection of multidrug-resistant HIV after initial therapy with nonnucleoside reverse transcriptase inhibitor-based regimens.
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Affiliation(s)
- Deborah Persaud
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abubaker Bedri
- Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
| | - Carrie Ziemniak
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anitha Moorthy
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Berhanu Gudetta
- Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
| | - Aida Abashawl
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Saad B. Omer
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | | | - Solomon Kumbi
- Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
| | - Rahel Adamu
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sileshi Lulseged
- Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
| | - Roxann Ashworth
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elham Hassen
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Ayele W, Assefa T, Lulseged S, Tegbaru B, Berhanu H, Tamene W, Ahmedin Z, Tensai BW, Tafesse M, Goudsmit J, Berkhout B, Paxton WA, deBaar MP, Messele T, Pollakis G. RNA Detection and Subtype C Assessment of HIV-1 in Infants with Diarrhea in Ethiopia. Open AIDS J 2009; 3:19-23. [PMID: 19554214 PMCID: PMC2701272 DOI: 10.2174/1874613600903010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/18/2009] [Accepted: 02/20/2009] [Indexed: 11/22/2022] Open
Abstract
In the absence of chemoprophylaxis, HIV-1 transmission occurs in 13-42% of infants born to HIV-1 positive mothers. All exposed infants acquire maternal HIV-1 antibodies that persist for up to 15 months, thereby hampering diagnosis. In resource limited settings, clinical symptoms are the indices of established infection against validated laboratorybased markers. Here we enrolled 1200 children hospitalized for diarrheal and other illnesses. 20-25% of those tested, aged 15 months or younger, were found to be HIV-1-seropositive. Where sufficient plasma was available, HIV-1 RNA detection was performed using a subtype-insensitive assay, with 71.1% of seropositive infants presenting with diarrhea showing positive. From sub-typing analysis, we identified that viruses of the C’ sub-cluster were predominated amongst infants. Although this study may overestimate the HIV-1 frequency through testing symptomatic infants, diarrhea can be seen as a useful marker indicating HIV-1 infection in infants less than 15 months old.
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Abstract
Yibeltal Assefa and colleagues describe the successes and challenges of the scale-up of antiretroviral treatment across Ethiopia, including its impact on other health programs and the country's human resources for health.
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Affiliation(s)
- Yibeltal Assefa
- Health Programs Department, National HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia.
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Bedri A, Gudetta B, Isehak A, Kumbi S, Lulseged S, Mengistu Y, Bhore AV, Bhosale R, Varadhrajan V, Gupte N, Sastry J, Suryavanshi N, Tripathy S, Mmiro F, Mubiru M, Onyango C, Taylor A, Musoke P, Nakabiito C, Abashawl A, Adamu R, Antelman G, Bollinger RC, Bright P, Chaudhary MA, Coberly J, Guay L, Fowler MG, Gupta A, Hassen E, Jackson JB, Moulton LH, Nayak U, Omer SB, Propper L, Ram M, Rexroad V, Ruff AJ, Shankar A, Zwerski S. Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials. Lancet 2008; 372:300-13. [PMID: 18657709 DOI: 10.1016/s0140-6736(08)61114-9] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND UNICEF/WHO recommends that infants born to HIV-infected mothers who do not have access to acceptable, feasible, affordable, sustainable, and safe replacement feeding should be exclusively breastfed for at least 6 months. The aim of three trials in Ethiopia, India, and Uganda was to assess whether daily nevirapine given to breastfed infants through 6 weeks of age can decrease HIV transmission via breastfeeding. METHODS HIV-infected women breastfeeding their infants were eligible for participation. Participants were randomly assigned to receive either single-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborns after birth) or 6 week extended-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborn babies after birth plus nevirapine 5 mg daily from days 8-42 for the infant). The randomisation sequences were generated by computer at a central data coordinating centre. The primary endpoint was HIV infection at 6 months of age in infants who were HIV PCR negative at birth. Analyses were by modified intention to treat, excluding infants with missing specimens and those with indeterminate or confirmed HIV infection at birth. These studies are registered with ClinicalTrials.gov, numbers NCT00074399, NCT00061321, and NCT00639938. FINDINGS 2024 liveborn infants randomised in the study had at least one specimen tested before 6 months of age (1047 infants in the single-dose group and 977 infants in the extended-dose group). The modified intention-to-treat population included 986 infants in the single-dose group and 901 in the extended-dose group. At 6 months, 87 children in the single-dose group and 62 in the extended-dose group were infected with HIV (relative risk 0.80, 95% CI 0.58-1.10; p=0.16). At 6 weeks of age, 54 children in the single-dose group and 25 in the extended-dose group were HIV positive (0.54, 0.34-0.85; p=0.009). 393 infants in the single-dose group and 346 in the extended-dose group experienced grade 3 or 4 serious adverse events during the study (p=0.54). INTERPRETATION Although a 6-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at 6 weeks of age, the lack of a significant reduction in the primary endpoint-risk of HIV transmission at 6 months-suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breast milk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high. FUNDING US National Institutes of Health; US National Institute of Allergy and Infectious Diseases; Fogarty International Center.
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Abegaz WE, Grossman Z, Wolday D, Ram D, Kaplan J, Sibide K, Wuhib T, Ismael S, Nkengasong J, Mekonen T, Berhanu H, Messele T, Lulseged S, Maayan S, Mengistu Y. Threshold survey evaluating transmitted HIV drug resistance among public antenatal clinic clients in Addis Ababa, Ethiopia. Antivir Ther 2008. [DOI: 10.1177/135965350801302s01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Expanded access to HIV therapy in the developing world raises serious concerns regarding the potential emergence and transmission of drug-resistant HIV strains. Although HIV drug resistance surveillance is recommended to track transmitted HIV drug resistance among newly infected individuals, the financial constraints in resource-limited countries prohibit such surveillance on a regular basis. The World Health Organization (WHO) recently introduced guidelines to address this issue. Methods A survey was conducted in Ethiopia following the WHO guidelines to assess transmitted HIV drug resistance among recently HIV-infected individuals in Addis Ababa. Antiretroviral drug usage started 3 years earlier than commencement of the current expanded access to antiretroviral therapy in Ethiopia. Results Of 75 eligible samples, 39 (52%) were successfully sequenced and genotyped in the protease and reverse transcriptase region, using both the ViroSeq® and TrueGene® genotyping systems, and analysed for drug resistance mutations using an algorithm from the Stanford HIV Reverse Transcriptase and Protease Database. The analysis revealed that transmitted HIV drug resistance in Addis Ababa is below the 5% threshold level for all three classes of antiretrovirals. Conclusions The current first-line antiretroviral therapy strategy can be used with confidence in Ethiopia at this time; however, Ethiopia should conduct similar periodic surveys that include the capitals of Ethiopia's larger regional states to ensure early detection of any changes in the country's HIV drug resistance trend.
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Affiliation(s)
- Woldaregay Erku Abegaz
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, Ethiopia
| | - Zehava Grossman
- Central Virology Laboratory, Sheba Hospital, Ministry of Health, Tel-Hashomer, Israel
| | - Dawit Wolday
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Daniela Ram
- Central Virology Laboratory, Sheba Hospital, Ministry of Health, Tel-Hashomer, Israel
| | - Jonathan Kaplan
- Centres for Disease Prevention and Control (CDC), Atlanta, Georgia, USA
| | - Kassim Sibide
- Centres for Disease Prevention and Control (CDC), Atlanta, Georgia, USA
| | - Tadesse Wuhib
- Centres for Disease Prevention and Control (CDC), Addis Ababa, Ethiopia
| | - Shabbir Ismael
- Centres for Disease Prevention and Control (CDC), Addis Ababa, Ethiopia
| | - John Nkengasong
- Centres for Disease Prevention and Control (CDC), Atlanta, Georgia, USA
| | - Teferi Mekonen
- Centres for Disease Prevention and Control (CDC), Addis Ababa, Ethiopia
| | - Hiwot Berhanu
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Tsehaynesh Messele
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- Centres for Disease Prevention and Control (CDC), Addis Ababa, Ethiopia
| | - Shlomo Maayan
- The AIDS Center, Hadassah University Hospital, Jerusalem, Israel
| | - Yohannes Mengistu
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, Ethiopia
- Centres for Disease Prevention and Control (CDC), Addis Ababa, Ethiopia
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Abegaz WE, Grossman Z, Wolday D, Ram D, Kaplan J, Sibide K, Wuhib T, Ismael S, Nkengasong J, Mekonen T, Berhanu H, Messele T, Lulseged S, Maayan S, Mengistu Y. Threshold survey evaluating transmitted HIV drug resistance among public antenatal clinic clients in Addis Ababa, Ethiopia. Antivir Ther 2008; 13 Suppl 2:89-94. [PMID: 18575196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Expanded access to HIV therapy in the developing world raises serious concerns regarding the potential emergence and transmission of drug-resistant HIV strains. Although HIV drug resistance surveillance is recommended to track transmitted HIV drug resistance among newly infected individuals, the financial constraints in resource-limited countries prohibit such surveillance on a regular basis. The World Health Organization (WHO) recently introduced guidelines to address this issue. METHODS A survey was conducted in Ethiopia following the WHO guidelines to assess transmitted HIV drug resistance among recently HIV-infected individuals in Addis Ababa. Antiretroviral drug usage started 3 years earlier than commencement of the current expanded access to antiretroviral therapy in Ethiopia. RESULTS Of 75 eligible samples, 39 (52%) were successfully sequenced and genotyped in the protease and reverse transcriptase region, using both the ViroSeq and TrueGene genotyping systems, and analysed for drug resistance mutations using an algorithm from the Stanford HIV Reverse Transcriptase and Protease Database. The analysis revealed that transmitted HIV drug resistance in Addis Ababa is below the 5% threshold level for all three classes of antiretrovirals. CONCLUSIONS The current first-line antiretroviral therapy strategy can be used with confidence in Ethiopia at this time; however, Ethiopia should conduct similar periodic surveys that include the capitals of Ethiopia's larger regional states to ensure early detection of any changes in the country's HIV drug resistance trend.
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Maedot P, Haile A, Lulseged S, Belachew A. Determinants of vct uptake among pregnant women attending two ANC clinics in Addis Ababa City: unmatched case control study. Ethiop Med J 2007; 45:335-342. [PMID: 18326343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND With HAART PMTCT interventions can reduce the risk of MTCT below 2%. However, low uptake of VCT is challenging effectiveness of PMTCT programs in sub-Saharan Africa. The aim of this study is to identify factors that determine VCT uptake among pregnant women attending ANC services. METHODS A case-control study was conducted from August 30, 2005 - November 30, 2005 among pregnant women attending ANC PMTCT services at Teklehaimanot Health Center and Gandhi memorial Hospital in Addis Ababa City. Cases were pregnant mothers who accepted VCT (n=202) and controls were pregnant mothers who refused VCT (n=200). Data was collected by counselor nurses working at the respective services RESULTS Factors that determine VCT acceptance were women's perceived ability to cope with a positive result (OR = 5.5, 95% CI 3.5-8.5, MHOR = 6.3, 95% CI 3.9-10.2); perceived favorable reaction of husband's after sharing positive test result (OR = 2.7 95% CI 1.4-5.1, MHOR = 2.9, 95% CI 1.4-5.7); perceived positive community response (OR = 2.2 95% CI 1.1-4.2, MHOR = 2.6 95% CI 1.3-5.2); perceived ability to get continuous medical care if found out to be positive (OR = 2.0, 95% CI 1.2-3.5, MHOR = 2.4, 95% CI 1.3-4.5). CONCLUSION Women's perceived ability to cope with a positive result, accesses to medical care, fear of husband's negative reaction and the stigma and discrimination following a positive test result were key determinants of uptake of VCT. Therefore, increasing uptake of VCT/PMTCT services needs policy makers and service providers' effort to promote couple counseling, intensifying the fight against stigma and discrimination and ensuring continuous HIV/AIDS related medical care.
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Affiliation(s)
- Paulos Maedot
- JHPIEGO Ethiopia, P.O Box-2881 Code 12 50, Addis Ababa, Ethiopia
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Lulseged S. Maternal and child health in Ethiopia: challenges in the AIDS era. Ethiop Med J 2006; 44:2 p following table of contents. [PMID: 17447370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Amsalu S, Lulseged S. Tetanus in a children's hospital in Addis Ababa: review of 113 cases. Ethiop Med J 2005; 43:233-40. [PMID: 16523643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
At Ethio-Swedish Children's Hospital Addis Ababa, Ethiopia, children admitted with a diagnosis of tetanus during January 1989- December 1998 were studied. During the 10 year study period there were 113 patients admitted with a diagnosis of tetanus. Sixty two (54.9%) of them were newborns and the rest 51 (45.1%) were children between the age of 1 and 12 years. Fifty six (90.3%) of the newborns were born at home and 43 (69.4%) of the mothers didn't have antenatal care. The median age on admission was 7 days. The umbilicus was assumed to be the portal of entry for all the cases with neonatal tetanus. Forty six (74.2%) of those with neonatal tetanus died in the hospital. Significantly high case fatality rate was seen in neonates with incubation period less than 7 days, onset time 48 hours or less, high pulse rate >140/minute and in those having fever. In non-neonates, the median age at admission was 9 years and the commonest site of entry was lesion on the lower extremities. Sixteen (31.4%) died in the hospital. The outcome was poor in those with onset time of 48 hours or less and in those presenting within 72 hours after the onset of illness. The overall mortality is high. Due attention needs to be given to children with tetanus having poor prognostic factors, particularly among newborns. Antenatal care needs to be promoted. A community based study is recommended to determine the true magnitude of the problem.
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Affiliation(s)
- Solomon Amsalu
- Department of Pediatrics and child health, Gondar University, P.O. Box 196, Gondar
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Wondale Y, Shiferaw F, Lulseged S. A systematic review of nutritional rickets in Ethiopia: status and prospects. Ethiop Med J 2005; 43:203-10. [PMID: 16370553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Nutritional rickets contributes to the high burden of illness and death among Ethiopian children below 5 years of age. Lack of adequate information appears to have negatively influenced the impact of prevention and treatment programs. OBJECTIVES The objective of this systematic review is to review existing body of knowledge about nutritional rickets in Ethiopia and develop recommendations that will guide development of strategies for effective interventions and research. METHODS Published and unpublished information on nutritional rickets in Ethiopia was collected systematically. The information was critically reviewed and discussed in the context of regional and global situation. RESULTS The major cause of nutritional rickets in Ethiopian children is lack of exposure to sunshine and/or inadequate intake of vitamin D. Lack of awareness and traditional beliefs are major causes for not exposing infants to sunshine. The disease is associated with poor socioeconomic status, low birth weight, protein-energy malnutrition and common childhood infections. Severe form of rickets is commonly seen at about 18 months of age. Rickets predisposes Ethiopian children to pneumonia. Diagnostic criteria used in most studies include two or more clinical signs and a characteristic radiological or biochemical abnormality. There are critical gaps in our knowledge about the epidemiology, ecology, and potentially effective interventions to prevent and treat rickets in Ethiopian children. CONCLUSION Most of the studies on nutritional rickets in Ethiopia have been conducted in hospital settings. There is a need for well designed epidemiological and ecological studies. The biologic basis for the striking association between PEM and active rickets seen in Ethiopia needs to be determined The role of calcium deficiency, the part played by genetic factors, the nature of the association between the duration of breastfeeding and rickets, and the role of complimentary feeds in Ethiopian children need to be explored. Studies are required to determine the amount of sunshine required to prevent rickets in Ethiopian infants. Studies are required to establish criteria for the diagnosis of clinical and sub clinical rickets, particularly in malnourished children. Prevention programs need to be pursued consistently and systematically and treatment options, including the single massive dose of vitamin D, need to be re-evaluated and optimal mode of treatment determined.
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Affiliation(s)
- Yimenu Wondale
- Department of Pediatrics and Child Health, Tikur Anbessa Specialized Hospital, Faculty of Medicine, Addis Ababa University, Ethiopia
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Teka T, Lulseged S. Living by the code in clinical research. Ethiop Med J 2005; 43:1 p preceding 71. [PMID: 16370534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Ali A, Lulseged S. Research on surgical disorders in Ethiopia: challenges and prospects. Ethiop Med J 2005; 43:1p preceding 1. [PMID: 16370522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Lulseged S, Bekele Z. Injuries: a largely unexplored public health problem. Ethiop Med J 2003; 41:209. [PMID: 15227885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Lulseged S, Assefa G. Authorship and accountability: the interface between research institutions and journals. Ethiop Med J 2003; 41:109. [PMID: 15227969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Lulseged S. Integrated management of childhood illness: a review of the Ethiopian experience and prospects for child health. Ethiop Med J 2002; 40:187-201. [PMID: 12240581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Pneumonia, diarrhea, malaria, measles and malnutrition account for over 70% of the 11.5 million deaths and 80-90% of sick child consultations in developing countries. These conditions often occur in combinations requiring a holistic approach of assessment, treatment and caretaker counseling. The Integrated management of Childhood Illness (IMCI) strategy has been developed to address these needs. Ethiopia contributed immensely to the development of IMCI and officially adopted it in 1997. Progress in terms of training and geographic expansion has been limited. This analytical review has been made to identify ways to strengthen and sustain IMCI implementation. Data were collected from published and unpublished information sources relevant to the IMCI strategy in Ethiopia and through key informant interviews with representatives of Federal Ministry of Health and its partners. The rationale for IMCI in Ethiopia, past, present and planned IMCI activities, related policies and strategies, strengths and weaknesses, and priorities have been analyzed and recommendations developed. The review identified that most of the childhood deaths and 40% of all disability-adjusted life years lost are associated with pneumonia, diarrhea, malaria, measles and malnutrition. IMCI has, thus, been adopted in 1997 as the main strategy for improving child health and included in the Health Sector Development Programme of the country. Three regions have piloted the strategy and their experience used to develop plans for expansion to other regions and also to initiate IMCI activities related to family and community practices. Much has been learnt from the pilot phase and from the country's involvement in the initial development of the strategy. There are critical gaps that need to be addressed for the IMCI strategy to exert the desired impact on child health in Ethiopia. The HIV/AIDS algorithm should be validated and included in the IMCI guidelines. There is a need for scaling-up training activities and carry out follow-up after training in 4-6 weeks. A standardized checklist needs to be developed and integrated into existing supervision protocols and this be used to supervise IMCI implementing facilities regularly. Strategies to train and involve lower level health cadres in IMCI implementation and modify the standard IMCI course to suit senior physicians and programme managers are required. Standard recording and reporting tools need to be developed and IMCI classifications harmonized with current MOH guidelines. Essential IMCI drugs should be available to health facilities. Interventions need to be identified and tools developed to support the IMCI implementation at community and family level. Continued advocacy for IMCI is required to secure support from all stakeholders. Planning for IMCI should set clear milestones and take into consideration central and regional capacities and ways to strengthen them. Operations research is required to guide policy development and planning for IMCI implementation. It should be included as an essential activity in strategic and annual plans for IMCI implementation in Ethiopia.
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Lulseged S, Sanders E. The fight against HIV/AIDS: opportunities and challenges. Ethiop Med J 2002; 40 Suppl 1:2p. [PMID: 12802825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Lulseged S, Deste C. Behavioural intention and factors influencing intention of Ethiopian mothers to expose infants to sunshine. ETHIOP J HEALTH DEV 2002. [DOI: 10.4314/ejhd.v16i1.9824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lulseged S, Sanders E. Ethiopian Medical Journal: looking into the future. Ethiop Med J 2001; 39:171-2. [PMID: 11921547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Bedri A, Lulseged S. Clinical description of children with HIV/AIDS admitted at a referral hospital in Addis Ababa. Ethiop Med J 2001; 39:203-11. [PMID: 11921551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Seventy-seven definitely HIV infected children were identified at Ethio-Swedish Children's Hospital in Addis Ababa, Ethiopia, between January 1990 and April 2000. There were 39 females and 38 males. Their age ranged from 15 months to 12 years and their median age was 3.8 years. Most commonly diagnosed diseases included disseminated tuberculosis seen in 28 patients, pneumonia in 27, pulmonary tuberculosis in 19, persistent or chronic diarrhoeal disease in 21, otitis media in 17 and marasmus in 17 patients. Pneumocystic carinii pneumonia was considered in 11 patients. One patient was suspected to have lymphoid interstitial pneumonitis. Sixteen children (21%) died in hospital. There was an abandoned child and 20 children were already orphans. All patients presented with clinical opportunistic infections and thus there is a need to develop a pediatric clinical guideline for patient management. Primary prevention of HIV infection in women of the child bearing age is of paramount importance and reduction of mother-to-child transmission of HIV infection by antiretroviral drug needs to be considered as a primary prevention for a child.
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Affiliation(s)
- A Bedri
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
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Ferede D, Geyid A, Lulseged S, Melaku A. Drug susceptibility pattern of bacterial isolates from children with chronic suppurative otitis media. ETHIOP J HEALTH DEV 2001. [DOI: 10.4314/ejhd.v15i2.9882] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Muhe L, Tilahun M, Lulseged S, Kebede S, Enaro D, Ringertz S, Kronvall G, Gove S, Mulholland EK. Etiology of pneumonia, sepsis and meningitis in infants younger than three months of age in Ethiopia. Pediatr Infect Dis J 1999; 18:S56-61. [PMID: 10530575 DOI: 10.1097/00006454-199910001-00010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METHODS Within a multicenter study coordinated by WHO, an investigation of the etiologic agents of pneumonia, sepsis and meningitis was performed among infants younger than 3 months of age seen at the Ethio-Swedish Children's Hospital in Addis Ababa for a period of 2 years. Of the 816 infants enrolled 405 had clinical indications for investigation. RESULTS There were a total of 41 isolates from blood cultures from 40 infants. The study showed that the traditionally known acute respiratory infection pathogen Streptococcus pneumoniae was most common in this extended neonatal age group, found in 10 of 41 blood isolates. Streptococcus pyogenes was a common pathogen in this setting (9 of 41 blood isolates), whereas Salmonella group B was found in 5 of 41 isolates. Streptococcus agalactiae, which is a common pathogen in developed countries, was absent. A study of the susceptibility pattern of these organisms suggests that a combination of ampicillin with an aminoglycoside is adequate for initial treatment of these serious bacterial infections, but the combination is not optimal for the treatment of Salmonella infections. Among 202 infants on whom immunofluorescent antibody studies for viruses were performed based on nasopharyngeal aspirates, respiratory syncytial virus was found in 57 (28%) infants, and Chlamydia trachomatis was isolated in 32 (15.8%) of 203 infants.
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Affiliation(s)
- L Muhe
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia
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Melaku A, Lulseged S. Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia. Ethiop Med J 1999; 37:237-46. [PMID: 11961874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Our knowledge of chronic suppurative otitis media is scanty in Ethiopia. This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa. Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire. A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media. Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years. Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%). Otalgia was reported in only 18%. Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically. Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents. Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus. A total of 106 bacterial isolates were cultured from ear discharges of 80 patients. Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics. All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive. Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment. Awareness about the health implications of the disease seemed to be lacking in among the caretakers. Selective use of antibiotics and continuous aural cleansing need to be promoted. More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia.
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Affiliation(s)
- A Melaku
- Ethio-Swedish Children's Hospital, Addis Ababa
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Lulseged S, Fitwi G. Vitamin D deficiency rickets: socio-demographic and clinical risk factors in children seen at a referral hospital in Addis Ababa. East Afr Med J 1999; 76:457-61. [PMID: 10520353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To test the association between vitamin D deficiency rickets and protein-energy malnutrition in Ethiopian children. SETTING Ethio-Swedish Children's Hospital, a tertiary health facility catering for children coming from Addis Ababa and the surrounding districts. DESIGN A case-control study. SUBJECTS One hundred and fifty seven children under three years of age who had vitamin D deficiency rickets constituted the cases. Controls were the same number of children matched with cases for sex and age within one month and were seen within a week of case recruitment. RESULTS Cases and controls were similar (p < 0.5) in terms of maternal education, paternal age, paternal education and family size. Factors strongly and independently associated with rickets were underweight, nutritional status [OR = 12.7 (95% CI 4.47-11.08)], marasmus [OR = 6.3 (95% CI 2.81-19.66)], lack of exposure to sunshine [OR = 3.5 (95% CI 1.33-5.84)] and non-married maternal marital status [OR = 5.1 (95% CI 2.90-10.62)]. CONCLUSION Protein-energy-malnutrition is strongly associated with vitamin D deficiency rickets. Intervention strategies targeting vitamin D deficiency rickets should give emphasis to children with protein energy malnutrition. Further work will be required to define the causal links between rickets and the risk factors identified in the present study.
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Affiliation(s)
- S Lulseged
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia
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Ketema L, Lulseged S. Persistent diarrhoea: socio-demographic and clinical profile of 264 children seen at a referral hospital in Addis Ababa. Ethiop Med J 1997; 35:161-8. [PMID: 9558754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute diarrhoea is a major public health problem in Ethiopian children under five years of age. Reports for other developing countries indicate that persistent diarrhoea is emerging as an important cause of mortality and morbidity in this age group. Little is, however, known about the extent of the condition in our setting. The socio-demographic and clinical characteristics of children with persistent diarrhoea seen at a teaching hospital in Addis Ababa over an 18-month period is presented. Of 5,762 children with all forms of diarrhoea seen during the study period 264 (5%) had persistent diarrhoea. Most of the children (83%) were below 18 months of age and the peak occurrence was between the ages of seven and 12 months. The majority (86%) of the patients had associated malnutrition and 83% of the infants under four months of age were either fully or partially weaned. Watery diarrhoea with no dehydration was the main clinical feature. Nearly 7% of the patients had dysentery. Average family income was low and parental literacy level seem to have had no effect. It is suggested that breastfeeding and appropriate weaning practices be strongly promoted. Further work is proposed in order to determine the magnitude of the problem and identify the risk factors associated with the disease, including the unfavourable child and family unit characteristics and care seeking behaviours.
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Affiliation(s)
- L Ketema
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University
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Abstract
BACKGROUND Pneumonia is the most important cause of morbidity and mortality in children aged under 5 years worldwide. Studies in developing countries have suggested an association between nutritional rickets and pneumonia. Since both nutritional rickets and pneumonia are common in Ethiopia, we did a case-control study to determine the role of nutritional rickets in the development of pneumonia. METHODS Cases were children younger than 5 years admitted to the Ethio-Swedish Children's Hospital during a 5-year period with a diagnosis of pneumonia (n = 521), but data were incomplete for 21 of these and they were not included. Controls (n = 500) were matched for admission within 3 months of cases and age within 3 months and had no evidence of pneumonia. Nutritional, demographic, and clinical and radiographic data for rickets and pneumonia were collected. Matched odd ratios and logistic regression were used to test the significance of the association of rickets and pneumonia. FINDINGS Rickets was present in 210 of 500 cases compared with 20 of 500 controls (odds ratio 22.11). There were significant differences between cases and controls for family size, birth order, crowding, and months of exclusive breastfeeding (p < 0.05). After correction for these confounding factors by logistic regression, there was still a 13-fold higher incidence of rickets among children with pneumonia than among controls (13.37 [95% CI 8.08-24.22], p < 0.001). INTERPRETATION Vitamin D or calcium deficiency may be important predisposing factors for pneumonia in children aged under 5 years in developing countries. Efforts to prevent vitamin D deficiency or calcium supplementation may result in significant reductions in morbidity and mortality from pneumonia in these children.
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Affiliation(s)
- L Muhe
- Department of Pediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia
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Ali M, Lulseged S. Factors influencing adolescent birth outcome. Ethiop Med J 1997; 35:35-42. [PMID: 9293145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In spite of a growing concern about adolescent pregnancy, factors that influence its birth outcome have remained inadequately defined. Data on sociodemographic variables, maternal health habits, medical and obstetric complications, and neonatal outcome measures were collected between October 1993 and May 1994. A total of 212 (110 adolescent and 102 non-adolescent) mothers and their newborns were included in the study. The data were analyzed using the EPI Info and the Statistical Analysis System softwares. Adolescent pregnancy was found to be associated with significantly higher rates of premature and low birth weight infants (p < .001). Newborns of adolescent mothers were also lower in other anthropometric parameters-length less than 45 cm (p < 0.001) and head circumference less than 32 cm (p < 0.003)- and had lower Apgar scores (< 7) at 1 and 5 minutes (p < 0.001). Gestational age was strongly and independently associated with birth weight. Low parity, lack of antenatal care, and young maternal age also had positive contributions to birth weight in descending order of strength. The findings of the present study suggest that factors other than young maternal age are strongly associated with poor adolescent birth outcome.
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Affiliation(s)
- M Ali
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University
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Shimeles D, Lulseged S. Clinical profile and pattern of infection in Ethiopian children with severe protein-energy malnutrition. East Afr Med J 1994; 71:264-7. [PMID: 8062777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The results of a prospective study on the clinical profile and pattern of infection in 90 Ethiopian children with severe protein-energy malnutrition (PEM) is presented. The study group consisted of 44(49%) with marasmus, 29(32%) with marasmic-kwashiorkor and 17(19%) with kwashiorkor. Their age ranged from 4 to 60 months and the median age at admission was 11.5, 15 and 20 months, respectively. Over 80% of the patients were infected and the lungs were the commonest sites. Bacterial pathogens, predominantly Gram negative enteric organisms, were isolated from 36% of blood and 37% of urine specimens. Tuberculosis and non-typhoidal salmonellae showed a higher tendency of causing disseminated disease. Rickets and overt vitamin A deficiency were seen in 37% and 17% of the patients, respectively. Septicaemia, gastroenteritis, pneumonia and disseminated tuberculosis accounted for an overall case fatality rate of 32%. Mortality was higher in children with total serum protein of 5gm% or less. The clinical profile and the pattern of infection varied from observations made elsewhere in developing countries which also showed discrepant results. More comprehensive and carefully designed work is proposed to elucidate the clinical and geographic heterogeneity of severe PEM.
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Affiliation(s)
- D Shimeles
- Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia
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