Barriers and facilitators to antiretroviral medication adherence among HIV-infected paediatric patients in Ethiopia: A qualitative study.

Medication adherence is a complex behaviour with multiple determinants. Understanding the barriers and facilitators of adherence is invaluable for programme improvement, which assists the foundation of adherence intervention strategies. A qualitative study was conducted in six selected hospitals of Addis Ababa in 2008, to explore barriers and facilitators to antiretroviral medication adherence among HIV-infected paediatric patients. Twelve caregivers of adherent and non-adherent children and 14 key informants in five hospitals were included in the study. The findings revealed that over-dosage (heavy pill burden), fear of stigma and discrimination, cost and access to transportation, lack of understanding of the benefit of taking the medication, economic problems in the household, and lack of nutritional support were the barriers to adherence to HAART. The presence of mobile/wall alarm, the presence of follow-up counselling, improved health of the child, ART clinic setups, and disclosure of HIV serostatus were among the facilitators. This study indicated that paediatric adherence to antiretroviral therapy faces a huge challenge. It suggests the provision of income-generating schemes to caregivers for assisting HIV-infected children. Health care providers should address proper usage of medication reminders

Alcohol drinking patterns among high school students in Ethiopia: a cross-sectional study

Abstract Background Alcohol use is an important risk factor for morbidity, mortality and social harm among adolescents. There is paucity of data on alcohol use among high school students in Ethiopia. This study aimed to determine the prevalence and factors associated with alcohol use among high school students in Ethiopia Methods A cross-sectional study was conducted to assess the prevalence of alcohol use and its predictors among high school students in eastern Ethiopia in April 2010. A sample of students was taken from all schools based on their enrollment size. Prevalence estimates and their 95% confidence intervals were calculated. Logistic regression was performed to adjust and examine associations. Results A total of 1721 students participated in the study. The mean age of the study population was 16.4 (SD 1.6) years. A total of 372 (22.2%; 95% CI 20.2 - 24.2%) students drink alcohol. Of these, 118 (31.7%) were females and 254 (68.3) males. Multivariate analysis indicated that males (OR 2.09; 95% CI 1.45-3.00), older age (OR 1.16; 95% CI 1.01-1.34), having friends who used alcohol (OR 10.09; 95% CI 6.84-14.89) and living with people who use alcohol (OR 2.77; 95% CI 1.89-4.07) increased the odds of drinking among students. Conclusion There is a high level of alcohol use among high school students in the study area. Involvement of parents, health workers and school authorities are necessary to avert the problem. Specifically, their involvement in awareness campaigns and peer education training are important to encourage students to avoid alcohol use.</p

Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users.

There are inconsistent findings about the relation between gender and HIV status disclosure. We conducted a facility-based crosssectional study, using qualitative and quantitative data collection methods, to explore gender differences in HIV-positive status disclosure among service users in south-west Ethiopia. Among 705 participants, an equal number of men and women (94.6% men v. 94.3%, women) indicated that they had disclosed their result to someone, and the majority (90.9% men v. 90.7% women) to their current main partner. 'It is customary to tell my partner everything' was the most frequently cited reason for disclosing (62.5% men v. 68.5% women). Reasons for non-disclosure varied by gender: men were concerned about their partner's worry and exposure of their own unfaithfulness. Women feared physical violence, and social and economic pressure in raising their children. Factors that influenced disclosure also indicated gender variation. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partner's HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partner's HIV status, advanced disease stage, having no more than primary education, being married, and perceiving the current relationship as long-lasting

Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study

Introduction: Isoniazid preventive therapy (IPT) reduces the risk of active TB. IPT is a key public health intervention for the prevention of TB among people living with HIV and has been recommended as part of a comprehensive HIV and AIDS care strategy. However, its implementation has been very slow and has been impeded by several barriers. Objective: The Objective of the study is to assess the perceived  barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource  constrained settings in Addis Ababa, Ethiopia in 2010.Methods: A qualitative study using a semi-structured interviewed guide was used for the in-depth  interview. A total of 12 key informants including ART Nurse, counselors and coordinators found in four hospitals were included in the interview. Each session of the in-depth interview was recorded via audio tape and detailed notes. The interview was transcribed verbatim. The data was analyzed manually. Results: the findings revealed that poor patient adherence was a major factor; with the following issues cited as the reasons for poor adherence; forgetfulness; lack of understanding of condition and patient non- disclosure of HIV sero-status leading to insubstantial social support; underlying mental health issues resulting in missed or irregular patient appointments; weak patient/healthcare provider relationship due to limited quality interaction; lack of patient information, patient empowerment and proper counseling on IPT; and the deficient reinforcement by health officials and other stakeholders on the significance of IPT medication adherence as a critical for positive health outcomes. Conclusion: Uptake of the  implementation of IPT is facing a challenge in resource limited settings. This recalled provision of  training/capacity building and awareness creation mechanism for the health  workers, facilitating disclosure and social support for the patients is recommended.Key words: Isoniazid preventive therapy, People Living with HIV, T

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

Abstract Background Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia. Methods A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings. Results A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons. Conclusion Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022</p

Participation and significance of self-help groups for social development: exploring the community capacity in Ethiopia

Abstract Background There are various Civil Society Organizations (CSOs) in Ethiopia among which the ‘Idir’ is a social and financial institution widespread both in urban and rural areas of the country. So the objectives of this study is to investigate how women members perceive the contribution of iddirs toward improving their lives and to determine whether and to what extent participation in iddirs has social impacts on their lives. Methods A cross-sectional qualitative study using Key Informant In-Depth Interviews (KII) and Focus Group Discussions (FGDs) was conducted in Addis Ababa, Addis Ketema Sub-city. Ethiopia. Data was collected using a semi-structured interview questionnaire and FGD guideline. Analysis of the data was made manually using thematic framework analysis method. Result Though their iddir doesn’t provide financial assistance, all the participants revealed the importance of installing credit mechanisms in their iddirs. However, they mentioned the inability of their respective iddirs in assisting members with their financial needs. One major difficulty mentioned was lack of capital. The participants demonstrated that the contribution of iddir in their well-being was more indispensable than the contributions of other voluntary associations they are acquainted with, such as iqub and mahiber. Especially iddir was regarded as crucial and unique in meeting emotional needs. As well, iddirs’ meetings are ideal places where women share experience; discuss issues of pressing concern and their worries. Other benefit of iddir include opportunities for social interaction, risk sharing and development of friendships, dispute resolution, Sharing and using timely information more effectively, Lower level of funeral services anxiety, Improvement of self confidence and leadership role, reciprocity and coexistence and trust. Conclusion Women’s iddirs are the viable basis in the creation of social network which plays crucial roles in providing solutions to social and economic challenges women are facing. There was a general consensus by the participants that their iddirs were unable to offer financial assistances. Enabling women’s iddirs to be independent of borrowing from banks is also indispensable and trainings on effective use of credits and the positive role of social capital formed in women’s iddirs is relevant. </jats:sec

Infertility: perceived causes and experiences in rural southwest Ethiopia

BACKGROUND: The experience of infertility causes harsh, poignant and unique difficulties to infertile individuals. In Ethiopia, very little has been explored regarding the way people perceive and experience infertility. This study attempted to describe perceived causes, experiences and perceptions of infertility in rural Ethiopia. METHODS: A community based cross-sectional study was conducted from May 12-26, 2005. Two hundred twenty-five randomly selected infertile individuals were included in the study. A pre-tested structured questionnaire was employed for data collection. Data were analyzed using SPSS for windows Version 11.0. RESULTS: Two hundred twenty-five infertile (167 women and 58 men) individuals participated in the study. The perceived cause of infertility in this study was mainly mystical power. One hundred Twenty (53.3%) of the respondents reported God’s wrath as the cause of infertility and 134 (59.6%) noted that it could be cured. The frequently reported methods of cure were God’s will 57 (42.5%) followed by modern medicine 56(41.8%). Forty-three (19 %) had history of sexually transmitted infections (STIs), and 62(28%) had extra marital sex for the sake of child bearing. Eighty-four (37.3%) of the participants faced some difficulty related to their infertility. One hundred thirty seven (60.9%) of the respondents hope to have a child in the future. CONCLUSION: This study showed that there is lack of knowledge of both causes and treatment of infertility in the study community. Therefore, community-based programs to increase public awareness and to reduce myths related to infertility are needed. Further community based study is recommended

The role of universal health coverage and global health security nexus and interplay on SARS-CoV-2 infection and case-fatality rates in Africa : a structural equation modeling approach

Background The Coronavirus Disease (COVID-19) caused by SARS-CoV-2 infections remains a significant health challenge worldwide. There is paucity of evidence on the influence of the universal health coverage (UHC) and global health security (GHS) nexus on SARS-CoV-2 infection risk and outcomes. This study aimed to investigate the effects of UHC and GHS nexus and interplay on SARS-CoV-2 infection rate and case-fatality rates (CFR) in Africa. Methods The study employed descriptive methods to analyze the data drawn from multiple sources as well used structural equation modeling (SEM) with maximum likelihood estimation to model and assess the relationships between independent and dependent variables by performing path analysis. Results In Africa, 100% and 18% of the effects of GHS on SARS-CoV-2 infection and RT-PCR CFR, respectively were direct. Increased SARS-CoV-2 CFR was associated with median age of the national population (β = -0.1244, [95% CI: -0.24, -0.01], P = 0.031 ); COVID-19 infection rate (β = -0.370, [95% CI: -0.66, -0.08], P = 0.012 ); and prevalence of obesity among adults aged 18 + years (β = 0.128, [95% CI: 0.06,0.20], P = 0.0001) were statistically significant. SARS-CoV-2 infection rates were strongly linked to median age of the national population (β = 0.118, [95% CI: 0.02,0.22 ], P = 0.024); population density per square kilometer, (β = -0.003, [95% CI: -0.0058, -0.00059], P = 0.016 ) and UHC for service coverage index (β = 0.089, [95% CI: 0.04,0.14, P = 0.001 ) in which their relationship was statistically significant. Conclusions The study shade a light that UHC for service coverage, and median age of the national population, population density have significant effect on COVID-19 infection rate while COVID-19 infection rate, median age of the national population and prevalence of obesity among adults aged 18 + years were associated with COVID-19 case-fatality rate. Both, UHC and GHS do not emerge to protect against COVID-19-related case fatality rate.publishedVersio

The role of multi-dimensional women’s empowerment in agriculture to improve the nutritional status of under-five children in rural cash crop producing, resource-limited settings of Ethiopia

Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6–59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P &gt; 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.<br/

Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets

Background: Ethiopia is the second-most populous country in Africa. Although most people still live in rural areas, the urban population is increasing. Generally, urbanisation is associated with a nutrition transition and an increase in risk factors for non-communicable diseases (NCDs). The objective of this study was to determine how the nutritional composition of the Ethiopian food supply has changed over the last 50 years and whether there is evidence of a nutrition transition. Methods: Food balance sheets for Ethiopia from 1961 to 2011 were downloaded from the FAOSTAT database and daily per capita supply for 17 commodity groupings was calculated. After appropriate coding, per capita energy and nutrient supplies were determined. Results: Per capita energy supply was 1710 kcal/d in 1961, fell to 1403 kcal/d by 1973, and increased to 2111 kcal/d in 2011. Carbohydrate was by far the greatest energy source throughout the period, ranging from 72% of energy in 1968 to 79% in 1998; however, this was mostly provided by complex carbohydrates as the contribution of sugars to energy only varied between 4.7% in 1994 and 6.7% in 2011. Energy from fat was low, ranging from 14% of energy in 1970 to 10% in 1998. Energy from protein ranged from 14% in 1962 to 11% in 1994. Per capita supplies of calcium, vitamin A, C, D, folate and other B-vitamins were insufficient and there was a low supply of animal foods. Conclusions: The Ethiopian food supply is still remarkably high in complex carbohydrates and low in sugars, fat, protein, and micronutrients. There is little evidence yet of changes that are usually associated with a nutrition transition