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Abstract
OBJECTIVES Ethiopia's HIV prevalence has decreased by 75% in the past 20 years with the implementation of antiretroviral therapy, but HIV transmission continues in high-risk clusters. Identifying the spatial and temporal trends, and epidemiologic correlates, of these clusters can lead to targeted interventions. METHODS We used biomarker and survey data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS). The spatial-temporal distribution of HIV was estimated using the Kulldorff spatial scan statistic, a likelihood-based method for determining clustering. Significant clusters (P < 0.05) were identified and compared based on HIV risk factors to non-cluster areas. RESULTS In 2005, 2011 and 2016, respectively, 219, 568 and 408 individuals tested positive for HIV. Four HIV clusters were identified, representing 17% of the total population and 43% of all HIV cases. The clusters were centred around Addis Ababa (1), Afar (2), Dire Dawa (3) and Gambella (4). Cluster 1 had higher rates of unsafe injections (4.9% vs. 2.2%, P < 0.001) and transactional sex (6.0% vs. 1.6%, P < 0.001) than non-cluster regions, but more male circumcision (98.5% vs. 91.3%, P < 0.001). Cluster 2 had higher levels of transactional sex (4.9% vs. 1.6%, P < 0.01), but lower levels of unsafe injections (0.8% vs. 2.2%, P < 0.01). Cluster 3 had fewer individuals with> 1 sexual partner (0% vs. 1.7%, P < 0.001) and more male circumcision (100% vs. 91.3%, P < 0.001). Cluster 4 had less male circumcision (59.1% vs. 91.3%, P < 0.01). CONCLUSIONS In Ethiopia, geographic HIV clusters are driven by different risk factors. Decreasing the HIV burden requires targeted interventions.
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Affiliation(s)
- Roger Ying
- Yale School of MedicineYale UniversityNew HavenCTUSA
| | - Lelisa Fekadu
- Department of Global Health and Primary CareUniversity of BergenBergenNorway
- Federal Ministry of HealthAddis AbabaEthiopia
| | - Bruce R. Schackman
- Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Stéphane Verguet
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
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2
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Irenso AA, Dessie Y, Berhane Y, Assefa N, Canavan CR, Fawzi WW. Prevalence and predictors of adolescent linear growth and stunting across the urban-rural gradient in eastern Ethiopia. Trop Med Int Health 2019; 25:101-110. [PMID: 31710743 DOI: 10.1111/tmi.13341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/07/2023]
Abstract
OBJECTIVE To assess the magnitude and factors associated with adolescent linear growth and stunting in two eastern Ethiopian communities. METHODS This cross-sectional study was conducted in the urban Harar Health Demographic Surveillance Site (HDSS) and rural Kersa Demographic Surveillance and Health Research Center (KDS-HRC). Univariate analysis was used to describe the data. Multiple regression models examined predictors of linear growth. Logistic regression was used to examine factors associated with stunting. RESULTS The study included 2010 adolescents. The prevalence of stunting was 26.9% (95% CI 24.9, 28.9), with 8.1% among urban adolescents (95% CI 6.5, 9.9) vs. 47.9% among rural ones (95% CI 44.6, 51.1). There was a significant interaction between residence and sex on the risk of stunting [AOR = 4.17 (95% CI 2.66, 9.9), P < 0.001], and height-for-age z score (HAZ) (β = -0.51, P < 0.001). For urban adolescents, older age (18 to 19 years) was negatively associated with linear growth (β= -0.29; P < 0.001). In the rural setting, handwashing practice after toileting was positively associated with HAZ (0.62; P < 0.001) and with lower risk of stunting [AOR = 0.51 (95% CI 0.34, 0.76)]. Urban females had significantly higher HAZ than urban males [β = 0.52; P < 0.01)], and a significantly lower risk of stunting [AOR = 0.29 (95% CI 0.18, 0.48)]. CONCLUSIONS There are significant disparities in the magnitude of stunting between urban and rural adolescents. The gender gap in stunting and linear growth, along with a high prevalence of stunting in early adolescence, calls for age-appropriate and gender-sensitive interventions. Particular attention and context-specific interventions are warranted for adolescents in these and similar rural eastern Ethiopian communities.
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Affiliation(s)
- Asnake Ararsa Irenso
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
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3
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Ebert CD, Astale T, Sata E, Zerihun M, Nute AW, Stewart AEP, Gessese D, Ayenew G, Ayele Z, Melak B, Chanyalew M, Gashaw B, Tadesse Z, Callahan EK, Jenness SM, Nash SD. Population coverage and factors associated with participation following a mass drug administration of azithromycin for trachoma elimination in Amhara, Ethiopia. Trop Med Int Health 2019; 24:493-501. [PMID: 30674087 PMCID: PMC6850572 DOI: 10.1111/tmi.13208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Mass drug administration (MDA) with azithromycin is a core component of the WHO‐recommended strategy to eliminate trachoma as a public health problem, but low participation rates in MDA campaigns may undermine the effectiveness of this intervention. We explored factors associated with individual MDA participation at the individual, head of household and household levels in Amhara, Ethiopia. Methods We conducted four district‐level, multilevel cluster random coverage surveys to collect data on self‐reported MDA participation and predictors. Random‐effects logistic regression modelling was used to identify correlates of MDA participation while adjusting for nesting of individuals at the household and village level. Results The district‐level self‐reported participation in the trachoma MDA ranged from 78.5% to 86.9%. Excellent and fair health status (Odds ratio [OR] = 5.77; 95% Confidence interval [CI]: 3.04, 10.95; OR = 7.08; 95% CI: 3.47, 14.46), advanced knowledge of the MDA campaign (OR = 2.93; 95% CI: 2.04, 4.21) and knowledge of trachoma (OR = 1.60; 95% CI: 1.17, 2.19) were all positively associated with MDA participation. When excluding heads of household from the model, correlates retained similar positive associations to participation, in addition to the head of household participation (OR = 3.34; 95% CI: 2.46, 4.54). Conclusions To increase the impact of MDA campaigns, MDA mobilisation strategies—including comprehensive trachoma and azithromycin messaging and MDA campaign awareness—should target heads of household, those in poorer health and older age groups.
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Affiliation(s)
- Caleb D Ebert
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tigist Astale
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
| | | | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Melsew Chanyalew
- Health Promotion and Disease Prevention Core Process, The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Bizuayehu Gashaw
- Directorate, The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
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4
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Jackson R, Kilsby D, Hailemariam A. Gender exploitative and gender transformative aspects of employing Health Extension Workers under Ethiopia's Health Extension Program. Trop Med Int Health 2019; 24:304-319. [PMID: 30582264 DOI: 10.1111/tmi.13197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/27/2022]
Abstract
OBJECTIVES To apply a gender lens to Ethiopia's Health Extension Program and the role of Health Extension Workers (HEWs). METHODS Interviews with 45 HEWs and four focus group discussions with 14 of the same HEWS from three regions in rural Ethiopia: Afar Region; Tigray Region (Adwa Woreda); and two locations in Southern Nations, Nationalities and People's Region (Aleta Wondo Woreda and Kafa Zone). Two focus group discussions were conducted in Afar Region with 17 Women Extension Workers employed by Afar Pastoralist Development Association. RESULTS Using the Gender Equality Continuum as a gender analysis tool, we found that Ethiopia's Health Extension Program is gender aware by directly linking improved health outcomes for women and their empowerment. However, for HEWs who inhabit a gendered space and place from home to district health centres, there can be unexpected consequences that accommodate existing gender inequalities, are blind to them and perhaps even generate new forms of exploitation. CONCLUSIONS The Health Extension Program could have more transformative outcomes for HEWs and also for communities if changing gender norms was given more attention and constraints to gender equality were reduced. Community Health Worker (CHW) programs should focus on better understanding on the role of gender for CHWs across health systems.
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Affiliation(s)
- Ruth Jackson
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia
| | - Di Kilsby
- Gender and Social Inclusion Consultancy, Melbourne, Australia
| | - Assefa Hailemariam
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
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Vermeiden T, Schiffer R, Langhorst J, Klappe N, Asera W, Getnet G, Stekelenburg J, van den Akker T. Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed-methods study based on 45 years of experience. Trop Med Int Health 2018; 23:1332-1341. [PMID: 30286267 DOI: 10.1111/tmi.13158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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 facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. METHODS Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. RESULTS The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. CONCLUSIONS Facilitators for MWH utilisation according to users and staff were perceived high-quality EmONC, integrated health services, awareness of pregnancy-related complications and the husband's support in overcoming barriers. If providing high-quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.
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Affiliation(s)
- Tienke Vermeiden
- Butajira General Hospital, Butajira, Southern Nations, Nationalities, and Peoples' Region, Ethiopia.,Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Rita Schiffer
- Attat Our Lady of Lourdes Catholic Primary Hospital, Welkite, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Jorine Langhorst
- Faculty of Medical Sciences, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Neel Klappe
- Faculty of Medical Sciences, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Wolde Asera
- Attat Our Lady of Lourdes Catholic Primary Hospital, Welkite, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Gashaw Getnet
- Butajira General Hospital, Butajira, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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6
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Abstract
How mothers perceive their infants' emotions and their subsequent responses are influenced by cultural values and beliefs. Mothers who live in particularly harsh environments may have perceptions about their infants' emotions that reflect not only cultural values but also constraints of the environment. In this qualitative study, 29 Gamo mothers living in rural Ethiopia were interviewed about perceptions of their infants' emotions, how they felt about these emotions, and what they believed their infants needed in response. Through constant comparative analysis and thematic coding, several patterns emerged in mothers' perceptions about their infants' emotions and what constituted appropriate responses. Mothers said that their infants' negative emotions were possibly related to illness and that appropriate responses were focused mostly on breastfeeding, complementary food, and needing to be held. Mothers also discussed their work demands and how they conflicted with their desire to respond to their infants; however, many mothers said that they relied on their older children to help. Mothers' responses were centered on a parenting strategy aimed at promoting infant health and survival, which is consistent with research on parents living in rural environments who subsist by farming and have relatively high risk for infant mortality.
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7
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Girma M, Wendaferash R, Shibru H, Berhane Y, Hoelscher M, Kroidl A. Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV-infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia. Trop Med Int Health 2017; 22:765-775. [PMID: 28407452 DOI: 10.1111/tmi.12881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/29/2022]
Abstract
OBJECTIVE To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. METHODS Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centres in Addis Ababa. Women were recruited during antenatal care and followed up with their newborns at delivery, Day 6 and Week 6 post-partum. Retention to PMCTC procedures, self-reported antiretroviral treatment (ART) adherence and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. RESULTS Of 494 women enrolled, 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% vs. 7.0%, P = 0.002) and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4 count (RR 1.7, 95% CI 1.0-3.0) and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive, 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. CONCLUSION High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention.
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Affiliation(s)
- Marshet Girma
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Center for International Health, University of Munich, Munich, Germany
| | | | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Michael Hoelscher
- Center for International Health, University of Munich, Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany.,German Centre for Infection Research, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany.,German Centre for Infection Research, Munich, Germany
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8
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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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Bouma MJ, Siraj AS, Rodo X, Pascual M. El Niño-based malaria epidemic warning for Oromia, Ethiopia, from August 2016 to July 2017. Trop Med Int Health 2016; 21:1481-1488. [PMID: 27580403 DOI: 10.1111/tmi.12776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/27/2022]
Abstract
OBJECTIVE Tropical highland malaria intensifies and shifts to higher altitudes during exceptionally warm years. Above-normal temperatures associated with El Niño during boreal winter months (December-March) may intensify malaria in East African highlands. We assessed the malaria risk for Oromia, the largest region of Ethiopia with around 30 million inhabitants. METHODS Simple linear regression and spatial analyses were used to associate sea surface temperatures (SST) in the Pacific and surface temperatures in Ethiopia with annual malaria risk in Oromia, based on confirmed cases of malaria between 1982 and 2005. RESULTS A strong association (R2 = 0.6, P < 0.001) was identified between malaria and sea surface temperatures in the Pacific, anticipating a 70% increase in malaria risk for the period from August 2016 to July 2017. This forecast was quantitatively supported by elevated land surface temperatures (+1.6 °C) in December 2015. When more station data become available and mean March 2016 temperatures from meteorological stations can be taken into account, a more robust prediction can be issued. CONCLUSION An epidemic warning is issued for Oromia, Ethiopia, between August 2016 and July 2017 and may include the pre-July short malaria season. Similar relationships reported for Madagascar point to an epidemic risk for all East African highlands with around 150 million people. Preparedness for this high risk period would include pre-emptive intradomestic spraying with insecticides, adequate stocking of antimalarials, and spatial extension of diagnostic capacity and more frequent reporting to enable a rapid public health response when and where required.
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Affiliation(s)
- M J Bouma
- London School of Hygiene and Tropical Medicine, London, UK. .,Catalan Institute of Climate Sciences, Barcelona, Spain.
| | - A S Siraj
- University of Notre Dame, Notre Dame, IN, USA
| | - X Rodo
- Catalan Institute of Climate Sciences, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - M Pascual
- University of Chicago, Chicago, IL, USA
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10
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Gudina EK, Tesfaye M, Adane A, Lemma K, Shibiru T, Pfister HW, Klein M. Challenges of bacterial meningitis case management in low income settings: an experience from Ethiopia. Trop Med Int Health 2016; 21:870-8. [PMID: 27145202 DOI: 10.1111/tmi.12720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia. METHODS This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records. RESULT A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%. CONCLUSION Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations.
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Affiliation(s)
| | - Markos Tesfaye
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Aynishet Adane
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kinfe Lemma
- Department of Internal Medicine, Hawassa University, Hawassa, Ethiopia
| | - Tamiru Shibiru
- Department of Internal Medicine, Arba Minch Hospital, Arba Minch, Ethiopia
| | | | - Matthias Klein
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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11
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Smartt C, Medhin G, Alem A, Patel V, Dewey M, Prince M, Hanlon C. Fatigue as a manifestation of psychosocial distress in a low-income country: a population-based panel study. Trop Med Int Health 2016; 21:365-72. [PMID: 26683692 PMCID: PMC4864398 DOI: 10.1111/tmi.12658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Fatigue is a common complaint worldwide and associated with disability and high health service use costs. We tested the hypothesis that maternal fatigue would be associated independently with maternal common mental disorder ('maternal CMD') in a rural, low-income country setting. METHODS The analysis was conducted using data from a population-based cohort located in the Butajira demographic surveillance site, Ethiopia. A total of 1065 women were recruited in pregnancy and followed up to 2.5 (n = 1009; 94.7%) and 3.5 years post-partum (n = 989; 92.9%). Maternal CMD symptoms were measured using a locally validated version of the Self-Reporting Questionnaire and fatigue was measured using a dichotomised item from the Patient Health Questionnaire-15. Physical health indicators included haemoglobin level, body mass index and illness episodes. Generalised estimating equations were used to conduct hypothesis-driven and exploratory multivariable analyses in the panel at 2.5 and 3.5 years. RESULTS The prevalence of maternal fatigue was 8.3% at 2.5 years and 5.5% at 3.5 years post-partum. Psychological symptoms of maternal CMD were associated independently with complaints of fatigue after adjusting for anaemia, body mass index, physical ill health, poverty and other confounding variables: adjusted odds ratio (aOR), 1.46; 95% confidence interval (CI), 1.28-1.66 for each one point increase in SRQ score. In the multivariable model, only psychosocial factors (CMD and stressful life events) and self-reported physical ill health were associated significantly with complaints of fatigue. CONCLUSION Complaints of fatigue are associated strongly with maternal CMD and other psychosocial risk factors in this rural, low-income country setting with a high burden of undernutrition and infectious disease. Fatigue should be understood as a potential indicator of CMD in primary care to improve detection and treatment.
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Affiliation(s)
- Caroline Smartt
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Girmay Medhin
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sangath, Goa, India
| | - Michael Dewey
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Prince
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
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Getnet G, Getie S, Srivastava M, Birhan W, Fola AA, Noedl H. Diagnostic performance of rapid diagnostic tests for the diagnosis of malaria at public health facilities in north-west Ethiopia. Trop Med Int Health 2015. [PMID: 26211505 DOI: 10.1111/tmi.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/27/2022]
Abstract
OBJECTIVE To assess the performance of RDTs against nested polymerase chain reaction (nPCR) for the diagnosis of malaria in public health facilities in north-western Ethiopia. METHODS Cross-sectional study at public health facilities in North Gondar, Ethiopia, of 359 febrile patients with signs and symptoms consistent with malaria. Finger prick blood samples were collected for testing in a P. falciparum/pan-malaria RDTs and for molecular analysis. Sensitivity, specificity and predictive values were determined for the RDTs using nPCR as reference diagnostic method. Kappa value was determined to demonstrate the consistency of the results between the diagnostic tools. RESULTS By RDTs, 22.28% (80/359) of patients tested positive for malaria, and by nPCR, 27.02% (97/359) did. In nPCR, 1.67% (6/359) and 0.28% (1/359) samples were positive for P. ovale and P. malariae, which had almost all tested negative in the RDTs. The sensitivity, specificity, positive and negative predictive values of RDTs for the diagnosis of malaria were 62.9%, 92.7%, 76.3% and 87.1%, respectively, with 0.589 measurement agreement between RDTs and nPCR. The sensitivity and specificity of RDTs for P. falciparum identification only were 70.8% and 95.2%, and 65.2% and 93.1% for P. vivax. CONCLUSION Although RDTs are commonly used at health posts in resource-limited environments, their sensitivity and specificity for the detection and species identification of Plasmodium parasites were poor compared to nPCR, suggesting caution in interpreting RDTs results. Particularly, in the light of expanded efforts to eliminate malaria in the country, more sensitive diagnostic procedures will be needed.
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Affiliation(s)
- Gebeyaw Getnet
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay Getie
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mitaly Srivastava
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Wubet Birhan
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe A Fola
- School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita, Ethiopia.,Walter and Eliza Hall Institute for Medical Research, Melbourne, Vic., Australia
| | - Harald Noedl
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
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Flecha MJ, Benavides CM, Tissiano G, Tesfamariam A, Cuadros J, de Lucio A, Bailo B, Cano L, Fuentes I, Carmena D. Detection and molecular characterisation of Giardia duodenalis, Cryptosporidium spp. and Entamoeba spp. among patients with gastrointestinal symptoms in Gambo Hospital, Oromia Region, southern Ethiopia. Trop Med Int Health 2015; 20:1213-1222. [PMID: 25939247 DOI: 10.1111/tmi.12535] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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
OBJECTIVES To assess the prevalence and genetic diversity of the enteric protozoa species G. duodenalis, Cryptosporidium spp. and Entamoeba histolytica in individuals with gastrointestinal symptoms compatible with infections by these pathogens seeking medical attention in a rural area in southern Ethiopia. METHODS A total of 92 stool samples were initially screened by direct microscopy and immunochromatography and further confirmed by molecular methods. G. duodenalis-positive samples were molecularly characterised by multilocus genotyping of the glutamate dehydrogenase and β-giardin genes of the parasite. PCR and DNA sequence analysis of the gene encoding the 60-kDa glycoprotein was used for the subtyping of Cryptosporidium isolates. Detection and differential diagnosis of E. histolytica/dispar were conducted by real-time PCR. RESULTS PCR-based prevalences were 10.9% for G. duodenalis, 1.1% for Cryptosporidium spp. and 3.3% for Entamoeba spp. Seven (four novel and three known) subtypes of G. duodenalis assemblage B were identified at the GDH locus and 5 (one novel and four known) at the BG locus. A novel variant of C. hominis subtype IbA9G3 was also identified. Two Entamoeba isolates were assigned to E. dispar and an additional one to E. histolytica. CONCLUSION Although preliminary, our results strongly suggest that giardiasis, cryptosporidiosis and amoebiasis represent a significant burden in Ethiopian rural population.
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Affiliation(s)
- María J Flecha
- Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | - Juan Cuadros
- Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Aida de Lucio
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - Begoña Bailo
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - Lourdes Cano
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - Isabel Fuentes
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - David Carmena
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
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Abstract
OBJECTIVES To assess the effect of distance to emergency obstetric and newborn care (EmONC) services on early neonatal mortality in rural Ethiopia and examine whether proximity to services contributes to socio-economic inequalities in early neonatal mortality. METHODS We linked data from the 2011 Ethiopian Demographic and Health Survey with facility data from the 2008 Ethiopian National EmONC Needs Assessment based on geographical coordinates collected in both surveys. Health facilities were classified based on the performance of nine EmONC signal functions (e.g. neonatal resuscitation, Caesarean section). We used multivariable logistic regression to assess the relationship between distance to services and early neonatal mortality. A decomposition approach was used to quantify the relative contributions of distance to EmONC services and other determinants to overall and socio-economic inequality in early neonatal mortality. RESULTS In general, closer proximity to EmONC services and higher level of care were associated with lower early neonatal mortality. Living more than 80 km from the nearest comprehensive EmONC facility able to perform all nine signal functions compared to living within 10 km was associated with an increase of 14.4 early neonatal deaths per 1000 live births (95% CI: 0.1, 28.7). Closer proximity to a substandard EmONC facility compared with no facility was not associated with lower early neonatal mortality. Distance to EmONC services was an important determinant of early neonatal mortality, although it did not make a significant contribution to explaining socio-economic inequality. CONCLUSIONS Our results suggest that recent initiatives by the Ethiopian government to improve geographical access to EmONC services have the potential to reduce early neonatal mortality but may not affect inequalities.
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Affiliation(s)
- Britt McKinnon
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Abstract
OBJECTIVES To identify entomological determinants of increased malaria transmission in the vicinity of the Koka reservoir in Central Ethiopia. METHODS Larval and adult mosquitoes were collected between August 2006 and December 2007 in villages close to (<1km) and farther away from (>6 km) the Koka reservoir. Adult mosquitoes were tested for the source of blood meal and sporozoites. RESULTS In reservoir villages, shoreline puddles and seepage at the base of the dam were the most productive Anopheles-breeding habitats. In villages farther from the dam (control villages), rain pools were important breeding habitats. About five times more mature anopheline larvae and six times more adult anophelines were found in the villages near the reservoir. Anopheles arabiensis and Anopheles pharoensis were the most abundant species in the reservoir villages throughout the study period. The majority of adult and larval anophelines were collected during the peak malaria transmission season (September-October). Blood meal tests suggested that A. arabiensis fed on humans more commonly (74.6%) than A. pharoensis (62.3%). Plasmodium falciparum-infected A. arabiensis (0.97-1.32%) and A. pharoensis (0.47-0.70%) were present in the reservoir villages. No P. falciparum-infected anophelines were present in the control villages. CONCLUSIONS The Koka reservoir contributes to increased numbers of productive Anopheles-breeding sites. This is the likely the cause for the greater abundance of malaria vectors and higher number of malaria cases evidenced in the reservoir villages. Complementing current malaria control strategies with source reduction interventions should be considered to reduce malaria in the vicinity of the reservoir.
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Affiliation(s)
- Solomon Kibret
- International Water Management Institute, Addis Ababa, Ethiopia International Water Management Institute, Pretoria, South Africa International Water Management Institute, Colombo, Sri Lanka International Water Management Institute, Vientiane, Laos
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