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van 't Noordende AT, Aycheh MW, Moges NA, Tadesse T, Schippers AP. Family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis versus usual care in Ethiopia: study protocol for a cluster-randomised controlled trial. BMJ Open 2022; 12:e056620. [PMID: 35354636 PMCID: PMC8968636 DOI: 10.1136/bmjopen-2021-056620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Leprosy, podoconiosis and lymphatic filariasis (LF) are three skin-related neglected tropical diseases. All three conditions can lead to temporary and permanent impairments. These impairments progressively worsen and are major determinants of stigma, discrimination and participation restrictions. Self-care is essential to prevent disabilities and chronic disease complications. Many persons with leprosy-related, LF-related and podoconiosis-related disabilities need to practice self-management routines their entire life. This is difficult without support and encouragement of others. The objective of this study was to assess the effectiveness of a family-based intervention in terms of physical outcomes related to prevention and self-management of disabilities due to leprosy, podoconiosis and LF and family quality of life and well-being compared with usual practice and care. METHODS AND ANALYSIS The study will use a cluster-randomised controlled trial design with two study arms. The project will be carried out in endemic districts in East and West Gojjam zones in the Amhara region in Ethiopia. Clusters consist of kebeles (lower administrative structures in the district) that have been merged, based on their geographical proximity and the number of cases in each kebele. A total of 630 participants will be included in the study. The intervention group will consist of 105 persons affected by leprosy, 105 persons affected by LF or podoconiosis, and 210 family members. The control group will consist of 105 persons affected by leprosy and 105 persons affected by LF or podoconiosis. The family-based intervention comprises an essential care package that consists of the following three main components: (1) self-management of disabilities, (2) economic empowerment and (3) psychosocial support. Participants in the control areas will receive usual practice and care. Data analysis includes, but is not limited to, calculating the percentage of change and corresponding 95% CI of physical impairment outcomes in each group, before and after the intervention is implemented, effect sizes, intention to treat and difference in difference analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Debre Markos University Health Sciences Institutional Research Ethics Review Committee. Results will be disseminated through peer-reviewed publications, conference presentations and workshops. TRIAL REGISTRATION NUMBER PACTR202108907851342.
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Affiliation(s)
- Anna Tiny van 't Noordende
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Technical Department, NLR, Amsterdam, The Netherlands
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nurilign Abebe Moges
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Tadesse
- Programme, Ethiopian National Association of Persons Affected by Leprosy (ENAPAL), Addis Ababa, Ethiopia
| | - Alice P Schippers
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Care ethics, University of Humanistic Studies, Utrecht, The Netherlands
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Tadesse T, Turi E, Wirtu D, Bikila H, Assefa L. Determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, Gambella Region, South-Western Ethiopia: Unmatched case–control study. SAGE Open Med 2022; 10:20503121211070727. [PMID: 35070312 PMCID: PMC8771739 DOI: 10.1177/20503121211070727] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Wasting among refugee children continues to be a serious public health problem particularly in conflict and in situations when people are displaced. Evidence of risk factors in the refugee context is crucial to successfully prevent malnutrition and its consequences. However, little information is known about the determinants of wasting in a refugee setting. Hence, this study was aimed to identify determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, South-Western Ethiopia. Methods: Institutional-based unmatched case–control study was conducted on 99 acute malnutrition children (cases) and 297 children who are not malnourished (control) from 6 April to 2 May 2019. The study participant was selected by systematic random sampling and data on exposure variables were collected by face-to-face interview using a structured questionnaire. Data were entered into Epi data version 3.1 and was exported to SPSS version 25 for further analysis. Descriptive, bivariable, and multivariable analyses were done to compute summary statistics and to identify determinants of wasting. Result: The mean age of the cases and controls with standard deviation (SD) was 13.8 (±6.9) and 19.2 (±8.7) months, respectively. Multi-variable analysis revealed that mothers who were unable to read and write (adjusted odds ratio = 3.26, 95% confidence interval (1.07–7.93)), fathers only decision-maker to use donations items in the household (adjusted odds ratio = 3.75, 95% confidence interval (1.28–10.85)), not used all donated refugee food and non-food items (adjusted odds ratio = 2.57; 95% confidence interval (1.17–5.66)), the incidence of diarrhea 2 weeks preceding the survey (adjusted odds ratio = 5.28, 95% confidence interval (2.31–12.04)), and mother’s smoking habit (adjusted odds ratio = 2.98, 95% confidence interval (1.19–7.44)) were significant determinants of wasting. Conclusion: The finding shows that mothers who are unable to read and write, father only decision-maker, parents’ smoking habit, not using all donated refugee food items, and diarrheal disease were found to be independent determinants of wasting. Hence, interventions on acute malnutrition which are focused on empowering women through training and strengthening their control over the household assets, proper utilization of donated food, and non-food items will play a paramount role.
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Affiliation(s)
| | - Ebisa Turi
- Department of Public Health, Wollega University, Nekemte, Ethiopia
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van‘t Noordende AT, Wubie Aycheh M, Tadesse T, Hagens T, Haverkort E, Schippers AP. A family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis in Ethiopia: A proof of concept study. PLoS Negl Trop Dis 2021; 15:e0009167. [PMID: 33600453 PMCID: PMC7924793 DOI: 10.1371/journal.pntd.0009167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/26/2020] [Revised: 03/02/2021] [Accepted: 01/20/2021] [Indexed: 01/31/2023] Open
Abstract
A key issue for persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities is the life-long need to practice self-management routines. This is difficult to sustain without regular encouragement and support of others. Family-based support may be a sustainable and feasible strategy to practice self-management routines. This proof of concept study aimed to develop and pilot a family-based intervention to support prevention and self-management of leprosy, lymphatic filariasis and podoconiosis-related disabilities in Ethiopia. We used a quasi-experimental pre/post intervention study design with a mixed methods approach. The study population included persons affected by leprosy, lymphatic filariasis and podoconiosis and their family members. All persons affected had visible impairments due to their condition. We collected physical impairment outcomes, data on activity limitations, stigma and family quality of life using the SALSA scale (range 0–80), the SARI stigma scale (range 0–63) and the Beach Centre Family Quality of Life scale (range 0–125) and conducted in-depth interviews and focus group discussions. Quantitative data were analysed using paired t-tests, unequal variances t-tests, linear regression and binary logistic regression. Qualitative data were coded using open, inductive coding and content analysis. The family-based intervention consisted of self-management of disabilities, awareness raising and socio-economic empowerment. The intervention was delivered over several monthly group meetings over the course of several months. A total of 275 (100%) persons affected attended at least one session with a family member, and 215 (78%) attended at least three sessions. There was no significant improvement in eye and hand problems after the intervention. However, foot and leg impairments, number of acute attacks, lymphedema and shoe wearing all significantly improved at follow-up. In addition, family quality of life significantly improved from 67.4 at baseline to 89.9 at follow-up for family members and from 76.9 to 84.1 for persons affected (p<0.001). Stigma levels significantly decreased from 24.0 at baseline to 16.7 at follow-up (p<0.001). Activity levels improved, but not significantly. This proof of concept study showed that the family-based intervention had a positive effect on impairments and self-management of disabilities, family quality of life and stigma. We recommend a large-scale efficacy trial, using a randomised controlled trial and validated measurement tools, to determine its effectiveness and long-term sustainability. A key issue for persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities is the life-long need to practice self-management routines. Family-based support may be a sustainable and feasible strategy to practice self-management. This proof of concept study aimed to develop and pilot a family-based intervention to support prevention and self-management of leprosy, lymphatic filariasis and podoconiosis-related disabilities in Ethiopia. We collected data on physical impairments, activity limitations, stigma and family quality of life, and conducted in-depth interviews and focus group discussions. The family-based intervention consisted of self-management of disabilities, awareness raising and socio-economic empowerment. The intervention was delivered over several monthly group meetings. A total of 275 persons affected attended at least one session with a family member. There was no significant improvement in eye and hand problems after the intervention. However, foot and leg impairments, number of acute attacks, lymphedema and shoe wearing all significantly improved. In addition, family quality of life significantly improved, and stigma levels significantly decreased after the intervention. Activity levels improved, but not significantly. This proof of concept study showed that the family-based intervention had a positive effect on impairments and self-management of disabilities, family quality of life and stigma.
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Affiliation(s)
- Anna T. van‘t Noordende
- Disability Studies in the Netherlands, Almere, the Netherlands
- NLR, Amsterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | - Tesfaye Tadesse
- Ethiopian National Association of Persons Affected by Leprosy (ENAPAL), Addis Ababa, Ethiopia
| | - Tanny Hagens
- The Leprosy Mission Ethiopia, Addis Ababa, Ethiopia
| | - Eva Haverkort
- Disability Studies in the Netherlands, Almere, the Netherlands
| | - Alice P. Schippers
- Disability Studies in the Netherlands, Almere, the Netherlands
- Amsterdam University Medical Centre, Location VU Medical Center, Amsterdam, The Netherlands
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Gebregergs GB, Alemneh M, Koye DN, Kassie Y, Assefa M, Ayalew W, Temesgen C, Klinkenberg E, Tadesse T. Poor symptomatic tuberculosis screening practices in a quarter of health centres in Amhara Region, Ethiopia. Public Health Action 2014; 4:S8-S12. [PMID: 26478513 DOI: 10.5588/pha.14.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/24/2014] [Accepted: 08/19/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING In 2011, Ethiopia introduced a strategy of symptomatic tuberculosis (TB) screening for patients attending out-patient services to increase identification of presumptive TB. OBJECTIVE To assess implementation and factors affecting symptomatic TB screening at out-patient departments in health centres in the Amhara Region, Ethiopia. DESIGN Using a cross-sectional study design, 86 randomly selected public health centres providing DOTS were included in the study. Data were captured by reviewing TB registers and interviewing key informants at out-patient services. RESULTS Of 86 health centres, 24 (28%) had poor symptomatic TB screening practices, defined as screening <80% of attending out-patients. Having an actively functioning multidisciplinary health centre team to assess TB services (aOR 2.29, 95%CI 2.23-30.80) and partner support for TB activities (aOR 4.84, 95%CI 1.05-22.40) were associated with higher TB screening rates, whereas availability of antiretroviral therapy was negatively associated. In all health centres combined, 1.6% of out-patient department attendees were identified as having presumptive TB. CONCLUSION A quarter of health centres had poor symptomatic TB screening practices in the out-patient services in this study. Strengthening multidisciplinary teams and expanding partner support are recommended to improve TB screening practices at out-patient services in Ethiopia.
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Affiliation(s)
- G B Gebregergs
- Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia ; Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - M Alemneh
- Bahir Dar Regional Health Research Laboratory Center, Bahir Dar, Ethiopia
| | - D N Koye
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Y Kassie
- Management Sciences for Health/HealTB, Addis Ababa, Ethiopia
| | - M Assefa
- Private Health Sector Program (PHSP), Abt Associates Inc, Addis Ababa, Ethiopia
| | - W Ayalew
- Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia
| | | | - E Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - T Tadesse
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tadesse T, Demissie M, Berhane Y, Kebede Y, Abebe M. Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia. Int J Tuberc Lung Dis 2013; 17:630-5. [PMID: 23575329 DOI: 10.5588/ijtld.12.0449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia. METHODS Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy. RESULTS A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12). CONCLUSION The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.
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Affiliation(s)
- T Tadesse
- Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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Tadesse T, Kumie A. Prevalence and factors affecting work-related injury among workers engaged in Small and Medium-scale industries in Gondar wereda, North Gondor zone, Amhara Regional State, Ethiopia. ETHIOP J HEALTH DEV 2007. [DOI: 10.4314/ejhd.v21i1.10028] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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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Abstract
The overall goal of the FIGO Save the Mothers Fund was to establish basic and comprehensive emergency obstetric care (EmOC) with the specific objectives of increasing the availability and utilization of quality obstetric care as measured by the UN indicators. As a result of this commitment by FIGO, the Ethiopian Society of Obstetricians and Gynecologists (ESOG) launched the Save the Mothers Project (SMP) in West Showa Zone (WSZ), Ethiopia in 1998 to implement and test a demonstration project and evaluate the feasibility and impact of the intervention. The overall objectives matched FIGO's-reducing maternal deaths by promoting the availability, access and utilization of EmOC services for women with complications of pregnancy and childbirth. The intervention package included capacity building as a major activity, and physicians and other service providers from Ambo Hospital, Shenen and Ijaji Health Centers were trained in EmOC. This was intended to combat the high staff turnover in the area. Equipment, materials and supplies were also provided to the demonstration sites to enable them provide basic and comprehensive EmOC services. The interventions, begun in 1999, led to improvements in availability, utilization and met need, which suggests that such an approach may eventually lead to the reduction of maternal deaths. The cesarean section rate for Ambo Hospital increased from 3.7% in 1998 to 17.3% in 2001--an almost six-fold increase. At Ambo Hospital both the total number of deliveries and cases admitted with obstetric complications have increased from baseline. Patients with obstructed labor comprise 39% of all obstetric patients making it the leading cause of hospitalization. Obstetric hemorrhage comes next with 24% of all admissions. The case fatality rate (CFR) (for direct maternal deaths) decreased from 7.2% at baseline, to 4.6% in 2001--showing a definite trend of improvement. Currently, there is 24-h EmOC service at Ambo Hospital where an obstetrician and general medical practitioners with EmOC training are responsible for the service. Shenen and Ijaji health Centers are upgraded in terms of training of staff members, provision of equipment and supplies, and regular supervision so that the community in these areas has access to basic EmOC services. To replicate similar activities, in a setting like ours, EmOC projects have to be low cost to attract decision-makers. The SMP used almost US dollars 100,000 over 3 years to ensure availability of EmOC services for women in WSZ. A favorable political climate such as maintenance of relative peace, and flexibility in adapting to local conditions also contributed to the success of the SMP.
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Affiliation(s)
- T Mekbib
- Population Council, Addis Ababa, Ethiopia.
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Abstract
Minimal inhibitory concentration (MIC) of benzylpenicillin (Pen G) against strains of Borrelia burgdorferi has earlier been determined by a recently developed dialysis culture technique which provides a constant concentration of Pen G. To further investigate this method, both MIC and minimal bactericidal concentration (MBC) of Pen G against B. burgdorferi were determined and the results were compared with those obtained by other authors using different methods. The incubation period was 7 days and subcultures for MBC were observed for a further 2 weeks. The study showed results of MIC and MBC similar to those of broth microdilution, indicating sensitivity, but lower values than the majority of MIC and MBC results reported by other authors using broth macrodilution. It is essential for the results of antibiotic sensitivity testing in vitro against slowly growing bacteria like Borrelia burgdorferi that the concentration of antibiotics such as Pen G, which are unstable in solution, is constant during the incubation period.
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Affiliation(s)
- S H Stiernstedt
- Karolinska Institute, Division of Infectious Diseases, Danderyd Hospital, Huddinge, Sweden
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Tekle-Haimanot R, Frommel D, Tadesse T, Verdier M, Abebe M, Denis F. A survey of HTLV-1 and HIVs in Ethiopian leprosy patients. AIDS 1991; 5:108-10. [PMID: 2059350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Akuffo H, Dietz M, Teklemariam S, Tadesse T, Amare G, Berhan TY. The use of itraconazole in the treatment of leishmaniasis caused by Leishmania aethiopica. Trans R Soc Trop Med Hyg 1990; 84:532-4. [PMID: 1965355 DOI: 10.1016/0035-9203(90)90028-d] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- H Akuffo
- Department of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
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Tadesse T. Functions of the hospital in a leprosy training institution. Ethiop Med J 1986; 24 Suppl 1:51-60. [PMID: 3609000] [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: 01/06/2023]
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Tadesse T. Functions of the hospital in a leprosy training institution. LEPROSY REV 1986; 57 Suppl 1:51-60. [PMID: 3586835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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