Response to the health and nutrition needs of people affected by drought emergency in Southeast Ethiopia

Background: Without well organized preparedness, early warning system and response, the consequence of drought would be catastrophic. Objective: The objective of this study was to assess the preparedness and response of different sectors for health and nutrition needs of people affected by drought in Southeast Ethiopia. Methods: This assessment was conducted from August 14 to September 7, 2006 in Borena, Afder and Liben zones in the Southeast Ethiopia. Interview with representatives of governmental and non-governmental organizations, record review, and focus group discussion with community leaders were done to assess the health and nutrition related responses of the different stakeholders. Results: Disaster Preparedness and Prevention Commissions (DPPC) at district level did not have documented contingency planning, vulnerability assessment and risk mapping and zoning related to drought emergency. Most of the districts’ health offices had no adequate human resources to respond to drought emergency. The surveillance system was not functional in all Districts. Eighty percent of the health institutions did not conduct nutritional survey or screening. None of the health facilities had temporary or therapeutic feeding centres. Most of the focus group discussants mentioned that the food and non-food aid was not timely and adequate.Conclusions: Absence of infrastructure, lack of human resources, absence of functional surveillance system, and weakness of DPPC offices were the serious bottlenecks which affected the health and nutrition related response of the drought emergency

Determinants of acceptance of voluntary HIV testing among antenatal clinic attendees at Dil Chora Hospital, Dire Dawa, East Ethiopia

Back ground: Voluntary Counseling and Testing (VCT) is one of the best interventions to reduce mother to child transmission of HIV. Despite the proven benefits of VCT, many women are not willing to have HIV testing.Objective: The objective of this study was to identify factors that determine the acceptance of voluntary HIV testing among pregnant women attending antenatal care at Dil Chora Hospital in Dire Dawa. Method: The study employed unmatched case control study which was conducted from August 20 to September 10, 2006. The study population consisted of 234 antenatal care followers. Cases were antenatal care followers who werecounseled and tested for HIV in the current pregnancy. Controls were antenatal care followers who were counseled but not tested for HIV in the current pregnancy. Data were collected by trained enumerators using structured questionnaire. Univariate and multivariate analysis was carried out using SPSS version 12.0.1 software. Results: The majority (79.5%) of respondents (97.4% of cases and 60.5% of controls) had good knowledge on HIV, mother to child transmission and VCT. Marital status; knowledge about HIV, mother to child transmission and VCT; attitude towards VCT; antenatal care follow up and perceived benefits of VCT were independent predictors of acceptance of voluntary HIV testing. Conclusion: Knowledge on MTCT and VCT, positive attitude towards VCT, antenatal care follow-up were predictors of acceptance of VCT. During the VCT session, health professionals should focus on knowledge, attitude, and benefitsof VCT

Determinants of under-five mortality in Gilgel Gibe Field Research Center, Southwest Ethiopia

Background: In developing countries like Ethiopia where there is no vital events registration system and laboratory diagnosis is lacking, causes of death in under-five children and its determinants could not be well known. The objective of this study was to investigate causes of death and its determinants in under-five children in Gilgel Gibe Field Research Center. Methods: A case-control study was conducted from December 12 to 27, 2005. Cases of under-five children who died between August 27, 2004 and September 22, 2005 and controls of alive children with the same age (+/-2 months) as cases were identified by a survey as the study population. Data were collected by trained enumerators using structured questionnaire adopted from World Health Organization (WHO). Causes of death were determined using the expert algorithm based on verbal autopsy data. Results: Neonatal and infant mortality rates were respectively 38 and 76.4 per 1000 live births. The two most common causes of death during neonatal period were prematurity (26.4%) and pneumonia (22.6%). Whereas the top causes of death in post-neonatal period were pneumonia (42%), malaria (37%) and acute diarrheal diseases (30%). Maternal education, practice and perception of mothers on the severity of illness and benefits of modern treatment were found to be independent predictor of child survival. Conclusion: Neonatal causes, pneumonia, malaria and diarrheal diseases were the major killers of under-five children in Ethiopia. In this study, practice of mothers and perceived benefits on the modern treatment are identified as the key predictors of child survival which are amenable to future intervention.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 117-12

Factors affecting fertility decisions of married men and women living with HIV in South Wollo Zone, Northeast Ethiopia

Background: In a setting with high HIV prevalence and high fertility rates, addressing fertility issues of People Living with HIV/AIDS (PLWHA) is crucial. However, understanding of the factors associated with fertility decisions of PLWHA in Ethiopia is remarkably low.Objective: The study was conducted to assess factors associated with fertility decisions of PLWHA in South Wollo Zone, Northeast Ethiopia.Methods: The study was conducted from February 1 to March 30, 2008 using cross-sectional design. Quantitative data were collected from a sample of 458 men and 458 women using structured questionnaire. Qualitative data were also collected from six health care providers. Logistic regression was used to analyze the quantitative data.Results: The study showed that 18.3% of currently married PLWHA have decided to have a child. The factors found to be independently associated with current decision to have a child were higher family income [OR (95% CI) = 2.29 (1.23, 4.26)], partner’s decision to have a child [OR (95% CI) = 36.4 (17.0, 77.5)], having knowledge on PMTCT [OR (95% CI) = 2.26 (1.44, 3.54)] and having partner with negative HIV test result [OR (95% CI) = 0.408 (0.219, 0.759)]. During in-depth interview the health care providers indicated the fertility related counseling service to be low.Conclusion: In spite of the fact that significant proportion of married PLWHA had decided to have a child, the fertility related counseling service is low. Improving fertility related counseling services to enable clients make informed fertility decision is mandatory. The factors identified to be associated with fertility decision could be of major importance and as such should be investigated further

Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study

BACKGROUND: Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia.METHODS: Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer.RESULTS: The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40-59 years), (OR= 4.7; 95%CI= 2.3-9.6), more than one husband (OR= 2.0; 95%CI=1.0-3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5-5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6-29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5-22.0) were statistically significant and the latter two were  independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of  controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done.CONCLUSION: Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral  communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.KEYWORDS: invasive cervical carcinoma, risk factors, Jimma, south west Ethiopi

Population Based Survey of Chronic Non-Communicable Diseases at Gilgel Gibe Field Research Center, Southwest Ethiopia

BACKGROUND: Chronic Non-communicable Diseases are increasingly becoming more prevalent and burden to the health care system in developing countries including Ethiopia. However, evidences showing the magnitude of the problem in those countries are scarce particularly in a community setting.The objective of this study was to determine the magnitude of chronic non communicable diseases in a community.METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center from late September 2008 to end of January 2009. A random sample of 4,469 individuals aged 15-64 years was studied. Data on characteristics and chronic symptom inventories were collected by interviewing study participants. Blood pressure was taken three times from each individual and blood sugar and lipid levels were determined after an overnight fasting. Data were analyzed using SPSS for Windows version 16.0 and STATA 11.RESULTS: The overall prevalence of CNCD was 8.9% (7.8% men and 9.8% women). The specific observed prevalence were 0.5% for diabetes mellitus (DM), 2.6% for hypertension, 3.0% for cardiovascular diseases, 1.5% for asthma and 2.7% for mental illness. In addition 3.1% and 9.3% of the study population had been informed to have DM and hypertension respectively.CONCLUSION: There is a high prevalence of CNCD among the study population indicating an immediate need for preventive action and also warrant further nationally representative study.Keywords: CNCD, Non-communicable, Prevalence, Southwest Ethiopi

Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.</p> <p>Methods</p> <p>The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.</p> <p>Results</p> <p>A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.</p> <p>Conclusion</p> <p>Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.</p> <p>Trail registration</p> <p>Australian New Zealand Clinical Trials Registry (ACTR number: <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a>).</p

The synergy between TB and HIV co-infection on perceived stigma in Ethiopia

<p>Abstract</p> <p>Background</p> <p>The synergy between tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection on perceived stigma is not well studied. The objective of this study was to assess the effect of TB/HIV co-infection on perceived stigma in selected hospitals of Oromiya region, Ethiopia. A cross sectional study was conducted from February to April, 2009 in Adama, Nekemet and Jimma Specialized hospitals. Data were collected by trained HIV counselors. A structured questionnaire which consisted of socio-demographic variables, clinical information, perceived stigma, and depression was used to collect the data</p> <p>Findings</p> <p>A total of 591 participants were included in the study of whom 124 (20.9%) were co-infected with TB/HIV. The stigma items were highly reliable (Cronbach's alpha = 0.93) and had strong inter dimension correlation. Respondents who were co-infected with TB and HIV were more likely to have perceived stigma compared to non-co-infected HIV patients, [OR = 1.4, (95% CI: 1.2, 2.0)]. Non-literate individuals [OR = 1.9, (95% CI: 1.2, 3.0)] and females [OR = 1.6, (95% CI: 1.2, 2.3)] had also more perceived stigma.</p> <p>Conclusions</p> <p>TB/HIV co-infected patients, non-literate individuals and females were more likely to have high perceived stigma. Behavioral Change Communication should focus on these segments of the population to rectify the high perceived stigma.</p

Common mental disorders in TB/HIV co-infected patients in Ethiopia

<p>Abstract</p> <p>Background-</p> <p>The relationship between TB/HIV co-infection and common mental disorders (CMD) has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia.</p> <p>Methods-</p> <p>We conducted a cross sectional study in three hospitals in Ethiopia from February to April, 2009. The study population consisted of 155 TB/HIV co-infected and 465 non-co-infected HIV patients. CMD was assessed through face to face interviews by trained clinical nurses using the Kessler 10 scale. Several risk factors for CMD were assessed using a structured questionnaire.</p> <p>Results-</p> <p>TB/HIV co-infected patients had significantly (p = 0.001) greater risk of CMD (63.7%) than the non-co-infected patients (46.7%). When adjusted for the effect of potential confounding variables, the odds of having CMD for TB/HIV co-infected individuals was 1.7 times the odds for non-co-infected patients [OR = 1.7, (95%CI: 1.0, 2.9)]. Individuals who had no source of income [OR = 1.7, (95%CI: 1.1, 2.8)], and day labourers [OR = 2.4, 95%CI: 1.2, 5.1)] were more likely to have CMD as compared to individuals who had a source of income and government employees respectively. Patients who perceived stigma [OR = 2.2, 95%CI: 1.5, 3.2)] and who rate their general health as "poor" [OR = 10.0, 95%CI: 2.8, 35.1)] had significantly greater risk of CMD than individual who did not perceive stigma or who perceived their general health to be "good".</p> <p>Conclusion-</p> <p>TB/HIV control programs should develop guidelines to screen and treat CMD among TB/HIV co-infected patients. Screening programs should focus on individuals with no source of income, jobless people and day labourers.</p