Intestinal parasites among HIV/AIDS patients attending University of Gondar Hospital, northwest Ethiopia

Background: Opportunistic intestinal parasitic infections are the major public health problem among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. In the absence of anti-retroviral therapy (ART), HIV/AIDS patients in developing countries such as Ethiopia continue to suffer from the consequences of intestinal parasites. This study aimed to determine the prevalence of opportunistic and other intestinal parasites among on-ART HIV/AIDS patients.Methods: A comparative cross-sectional study was conducted from December 2015 to January2016 among pre-ART and on-ART adult HIV/AIDS patients at University of Gondar Hospital, northwest Ethiopia. A pre-tested structured questionnaire was used to collect data on socio-demographic and associated risk factors. Systematic random sampling was used to select the study participants. Stool samples were collected and processed using a direct, wet-mount, formol-ether concentration technique and modified Ziehl-Neelsen staining technique. The CD4 counts were estimated by using the BD FACS Count system. Data were entered and analyzed using SPSS 20 software.Results: A total of 150 study participants (48ARTnaïve and102 on ART) were included in the study. The overall prevalence of intestinal parasitic infections was 45.3% – 25.3% in pre-ART patients and 20% in on-ART patients. Two thirds (8/12) of opportunistic parasitic infections were found in the ART-naïve patients and significantly associated with CD4 counts <200 cells/mm3. Those who have no toilet [AOR=5.21, 95% CI: 1.82, 16.03], source of water from stream [AOR = 2.8; 95% CI: 1.05, 7.72], who have diarrhea [AOR = 11.38; 95% CI: 4.69, 15.61], WHO stage III [AOR =5.3; 95% CI: 2.47, 11.56] and ART status [AOR = 4.2; 95% CI: 2.02, 8.77] were significantly associated with the prevalence of intestinal parasites.Conclusions: The prevalence of intestinal parasites was found to be higher in ART-naïve than on-ART patients. High proportions of intestinal parasites were associated with lower CD4 counts, ART naïve, diarrhea, WHO stage III, absence of toilet and source of water from stream. Therefore, public health measures and adherence to ART for ART naïve should be strengthened to improve the quality of life of these patients. [Ethiop.J. Health Dev. 2019; 33(2):65-72]Key words: Opportunistic intestinal parasites, CD4 T-cells, Anti-retroviral therapy, diarrhea, Gonda

How schools can help to build healthy, productive lives, free of trachoma

Children can be effective behaviour-change ambassadors and schools can act as key sites for health interventions to combat trachoma, especially when awareness forms part of the curriculum. These examples from Morocco and Ethiopia illustrate the important role that schools can play in efforts to end trachoma

Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross‑sectional study

Background: There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. Methods: A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. Results: No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09). Conclusion: In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention

Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia

Background: Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting. Methods: A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. Multivariate analysis was conducted to examine the association between antenatal depressive symptoms and self-reported perinatal complications. Result: A total of 28.7% of women had antenatal depressive symptoms (PHQ-9 score ≥ 5). Women with antenatal depressive symptoms had more than twice the odds of self-reported complications in pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and the postpartum period (OR=1.70, 95% CI: 1.23, 2.35) compared to women without these symptoms. There was no association between antenatal depressive symptoms and pregnancy loss or neonatal death. Conclusion: Antenatal depressive symptoms are associated prospectively with self-reports of perinatal complications. Further research is necessary to further confirm these findings in a rural and poor context using objective measures of complications and investigating whether early detection and treatment of depressive symptoms reduces these complications

The effect of psychosocial factors and patients’ perception of tuberculosis treatment non-adherence in Addis Ababa, Ethiopia

Background: Although there are several studies reported on factors affecting tuberculosis (TB) treatment non-adherence, there is information gap on psychosocial and patients’ perceptions aspects. Therefore, this study was aimed to investigate the effect of psychosocial factors and patients’ perceptions on TB treatment non-adherence in Ethiopia.Methods: A cross sectional study was conducted in Addis Ababa from May to December, 2014. Thirty one health facilities were randomly selected and 698 TB patients, who had been on treatment, were enrolled consecutively using patient registration number. Structured questionnaire was used to collect data on demographics, knowledge, psychological distress, alcohol use, tobacco smoking and six HBM domains. Treatment adherence level was the main outcome variable, and it measured using visual analog scale. Statistical Package for Social Sciences version 20 was used for data analysis.Results: Non-adherence level within last one month prior to the study was 19.5%. After controlling for all potential confounding variables, Antiretroviral Therapy (ART) status (Adjusted Odds Ratio (AOR) = 1.79, 95% Confidence interval (CI) (1.09 -2.95)), alcohol use (AOR = 2.11, 95% CI (1.33-3.37)), economic status (AOR = 0.53, 95% CI (0.33-0.82)), perceived barriers (AOR = 1.21, 95% CI (1.10-1.47)) and psychological distress (AOR = 1.83, 95% CI (1.47-2.29)) were independently associated with TB treatment non-adherence.Conclusion: ART status, economic status, alcohol use, perceived barrier and psychological distress are the major areas that need to be targeted with health promotion intervention to enhance TB treatment adherence.Keywords: Treatment Non-adherence, Determinants of treatment non-adherence, Health Belief Model, Tuberculosi

Prevalence and associated factors of TB/HIV co-infection among HIV Infected patients in Amhara region, Ethiopia.

Background: Tuberculosis is one of the world\u2019s most common causes of death in the era of Human immunodeficiency virus. The purpose of this study was to determine the prevalence and associated factors of TB/HIV co-infection. Methods: Hospital based retrospective studies were conducted among adult HIV-positive patients. Logistic regression method and Chi square test were applied. Results: A total of 571 HIV positive study participants were enrolled. Of these, 158 (27.7%) were found to have pulmonary tuberculosis. Lower baseline CD4 count&lt;200cell/\u3bcl, patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients whose marital status was single were significant predictors for increased risk of tuberculosis in PLWHIV (P &lt;0.05). Non smoker patients, patients in WHO clinical stage I, patients in WHO clinical stage II and ownership of the house had significant protective benefit against risk of TB (P &lt;0.05). Conclusion: The prevalence of TB/HIV co-infection in adults on ART in our study was moderately high. Having advanced clinical status and presence of risk factors were found to be the predicting factors for co-infection. The health office should open TB/HIV co-infection units in the hospitals and health workers should be cautious when a patient has an advanced disease

Catastrophic out‑of‑pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia

Background: There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. Methods: A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. Results: The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). Conclusions: Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, the entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage

Prevalence of medication non-adherence and associated factors among diabetic patients in a tertiary hospital at Debre Markos, Northwest Ethiopia

BACKGROUND: Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital.METHODS: A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05.RESULTS: A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications.CONCLUSION: The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients