Retrospective review of antiretroviral therapy program data in accredited private hospitals in Addis Ababa City Administration, Ethiopia

Background: Ethiopia is committed to improving access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ART) service. In May 2005, some private hospitals in Addis Ababa City Administration received accreditation to provide ART services to eligible patients.Objective: To examine and describe the achievements of the ART Program in accredited private hospitals.Methods: Descriptive retrospective analyses of reported ART Program Data from accredited private hospitals, between May 2005 and 31st December 2009. The aggregate data was obtained from Addis Ababa Regional Health Bureau and consisted of information about patients enrolled for care, those who started ART, and those presently are on ART.Results: During the study period, 10,849 patients were enrolled for care, 9,442 who had just started ART and 5,608 already on it across the study private facilities. In general close to 75% of the total patients enrolled for  care at five facilities. Although the majority (87%) had started treatment in the past, only 59.4% were currently on treatment. Overall, the program retained 66.4% of the patients (n=6,270) and attrition was 32% (n=3,021).Conclusions: Differences in patient enrollment for care, ART initiation and retention were observed across facilities. A significant number of patients discontinued treatment and their outcome status was unclear. A better monitoring and reporting of ART Program Data will improve program quality. An effective strategy is needed to enhance patient retention and tracing in the accredited private hospitals in Addis Ababa City Administration. [Ethiop J Health Dev. 2011;25(2):110-115

Videovoice diaries to understand the perspectives of community health volunteers in Ethiopia: insights from collaborative qualitative research

Background: Audio-visual diary to collect data on daily routines of study participants is relatively new in health systems research. The concept uses participatory research techniques to elicit participants' views, priorities and empower them to take action. Methods: We discuss a collaborative qualitative study conducted by university researchers, rural communities and health managers (Southwest Ethiopia). We used Videovoice to understand the role of community health volunteers as mediators of accessible and responsive Primary Health Care in Ethiopia. Footage is obtained from 30 Health Development Army leaders in 3 diverse districts, over 3–4 months. Following community engagement and training, participants received an encrypted phone with recording capability. They are supported by researchers through regular contacts, to establish trust, support, and reduce social desirability. A co-production workshop with participants and researchers to interpret the findings will be held. Results: Employing Videovoice diaries demonstrates that collaborations involving academic researchers, community members and volunteers (as lay researchers) and managers have considerable benefits as well as challenges. Videovoice shifts power to the participants: they determine what to capture, what is important and how to convey their views and activities. Data is enriched by participant-generated insights into the reasons behind their decisions. Intensive engagement, effective communication and trust are essential in understanding constraints and preferences of their role, and interpreting findings. A multi-disciplinary research team will enhance the analytical process. Discussion: Videovoice can be a useful tool in enabling lay researchers to describe their daily life, better understand their needs, and identify mechanisms for change. The approach can strengthen the immediacy of the research, capturing perceptions within context. Co-production will involve a significant shift in power and emergence of new directions

Body mass index trajectories in early childhood in relation to cardiometabolic risk profile and body composition at 5 years of age

BACKGROUND: Both impaired and accelerated postnatal growth have been associated with adult risks of obesity and cardiometabolic diseases, like type 2 diabetes and cardiovascular disease. However, the timing of the onset of cardiometabolic changes and the specific growth trajectories linking early growth with later disease risks are not well understood. OBJECTIVES: The aim of this study was to identify distinct trajectories of BMI growth from 0 to 5 y and examine their associations with body composition and markers of cardiometabolic risk at age 5 y. METHODS: In a prospective birth cohort study of 453 healthy and term Ethiopian children with BMIs assessed a median of 9 times during follow-up, we identified subgroups of distinct BMI trajectories in early childhood using latent class trajectory modeling. Associations of the identified growth trajectories with cardiometabolic markers and body composition at 5 y were analyzed using multiple linear regression analyses in 4 adjustment models for each outcome. RESULTS: We identified 4 heterogeneous BMI growth trajectories: stable low BMI (19.2%), normal BMI (48.8%), rapid catch-up to high BMI (17.9%), and slow catch-up to high BMI (14.1%). Compared with the normal BMI trajectory, children in the rapid catch-up to high BMI trajectory had higher triglycerides (TGs) (range of β-coefficients in Models 1-4: 19-21%), C-peptides (23-25%), fat masses (0.48-0.60 kg), and fat-free masses (0.50-0.77 kg) across the 4 adjustment models. Children in the stable low BMI trajectory had lower LDL cholesterol concentrations (0.14-0.17 mmol/L), HDL cholesterol concentrations (0.05-0.09 mmol/L), fat masses (0.60-0.64 kg), and fat-free masses (0.35-0.49 kg), but higher TGs (11-13%). CONCLUSIONS: The development of obesity and cardiometabolic risks may be established already in early childhood; thus, our data provide a further basis for timely interventions targeted at young children from low-income countries with unfavorable growth patterns. The birth cohort was registered at ISRCTN as ISRCTN46718296

Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years:The Ethiopian iABC birth cohort study

BackgroundAccelerated growth in early childhood is an established risk factor for later obesity and cardiometabolic disease, but the relative importance of fat mass (FM) and fat-free mass (FFM) accretion is not well understood. We aimed to study how FM and FFM at birth and their accretion during infancy were associated with body composition and cardiometabolic risk markers at 5 years.Methods and findingsHealthy children born at term were enrolled in the Infant Anthropometry and Body Composition (iABC) birth cohort between December 2008 and October 2012 at Jimma University Specialized Hospital in the city of Jimma, Ethiopia. FM and FFM were assessed using air displacement plethysmography a median of 6 times between birth and 6 months of age. In 507 children, we estimated individual FM and FFM at birth and their accretion over 0-3 and 3-6 months of age using linear-spline mixed-effects modelling. We analysed associations of FM and FFM at birth and their accretion in infancy with height, waist circumference, FM, FFM, and cardiometabolic risk markers at 5 years using multiple linear regression analysis. A total of 340 children were studied at the 5-year follow-up (mean age: 60.0 months; girls: 50.3%; mean wealth index: 45.5 out of 100; breastfeeding status at 4.5 to 6 months post-partum: 12.5% exclusive, 21.4% almost exclusive, 60.6% predominant, 5.5% partial/none). Higher FM accretion in infancy was associated with higher FM and waist circumference at 5 years. For instance, 100-g/month higher FM accretion in the periods 0-3 and 3-6 months was associated with 339 g (95% CI: 243-435 g, p ConclusionsFM accretion in early life was positively associated with markers of adiposity and lipid metabolism, but not with blood pressure and cardiometabolic markers related to glucose homeostasis. FFM accretion was primarily related to linear growth and FFM at 5 years

002 BP: VIDEOVOICE DIARIES TO UNDERSTAND THE PERSPECTIVES OF COMMUNITY HEALTH VOLUNTEERS IN ETHIOPIA: INSIGHTS FROM COLLABORATIVE QUALITATIVE RESEARCH

Background Audio-visual diary to collect data on daily routines of study participants is relatively new in health systems research. The concept uses participatory research techniques to elicit participants' views, priorities and empower them to take action. Methods We discuss a collaborative qualitative study conducted by university researchers, rural communities and health managers (Southwest Ethiopia). We used Videovoice to understand the role of community health volunteers as mediators of accessible and responsive Primary Health Care in Ethiopia. Footage is obtained from 30 Health Development Army leaders in 3 diverse districts, over 3–4 months. Following community engagement and training, participants received an encrypted phone with recording capability. They are supported by researchers through regular contacts, to establish trust, support, and reduce social desirability. A co-production workshop with participants and researchers to interpret the findings will be held. Results Employing Videovoice diaries demonstrates that collaborations involving academic researchers, community members and volunteers (as lay researchers) and managers have considerable benefits as well as challenges. Videovoice shifts power to the participants: they determine what to capture, what is important and how to convey their views and activities. Data is enriched by participant-generated insights into the reasons behind their decisions. Intensive engagement, effective communication and trust are essential in understanding constraints and preferences of their role, and interpreting findings. A multi-disciplinary research team will enhance the analytical process. Discussion Videovoice can be a useful tool in enabling lay researchers to describe their daily life, better understand their needs, and identify mechanisms for change. The approach can strengthen the immediacy of the research, capturing perceptions within context. Co-production will involve a significant shift in power and emergence of new directions

Higher weight and weight gain after 4 years of age rather than weight at birth are associated with adiposity, markers of glucose metabolism, and blood pressure in 5-year-old Ethiopian children

BACKGROUND: Fetal and early life growth is associated with adult risk of obesity and cardiometabolic disease. However, little is known about the relative importance of birth weight and successive periods of weight gain on markers of cardiometabolic risk in childhood in low-income populations. // OBJECTIVES: The objective was to study associations of birth weight and weight gain velocities in selected age intervals from birth to 60 mo with height, fat-free mass (FFM), and markers of adiposity and cardiometabolic risk at 60 mo. // METHODS: In a prospective cohort study of 375 Ethiopian children aged 60 mo, we estimated individual weight gain velocities in the periods between birth and 3, 6, 24, 48, and 60 mo using linear-spline mixed-effects modeling. Subsequently, we analyzed associations of birth weight, weight gain velocities, and current weight with height, FFM, and markers of adiposity and cardiometabolic risk. // RESULTS: Weight gain from 48 to 60 mo and weight at 60 mo rather than birth weight were the strongest correlates of insulin, C-peptide, HOMA-IR, blood pressure, height, FFM, waist circumference, and fat mass at 60 mo. For instance, 1 SD higher (1 SD = 50 g/mo) weight accretion from 48 to 60 mo was associated with a higher insulin of 23.3% (95% CI: 9.6%, 38.8%), C-peptide of 11.4% (2.7%, 20.8%), systolic blood pressure of 1.4 mm Hg (0.6, 2.3 mm Hg), fat mass of 0.72 kg (0.59, 0.85 kg), and FFM of 0.70 kg (0.56, 0.85 kg). Weight gain from 0 to 3 mo was positively associated with LDL cholesterol, systolic blood pressure, height, and the body composition indices, and weight gain from 24 to 48 mo was inversely associated with blood glucose. // CONCLUSIONS: In 60-mo-old Ethiopian urban children, weight gain and weight after 48 mo rather than weight at birth may represent a sensitive period for variations in markers of adiposity and glucose metabolism. The birth cohort is registered at https://www.isrctn.com/ as ISRCTN46718296

Reducing Calf Mortality in Ethiopia

SIMPLE SUMMARY: Disease and death of young livestock cause financial and production difficulties to farmers around the world. High rates of disease and death occur in various production systems in Ethiopia, hampering livestock production, reducing incomes, and damaging livelihoods. Over the last 10 years, studies carried out in Ethiopia have reported death and disease incidence rates in young livestock as high as 31% and 67%, respectively. Diarrhea and respiratory infections are the two leading causes of disease and death in calves in all production systems. In this paper, we describe findings from the experience of the Young Stock Mortality Reduction Consortium. This unique group produced important information on the main causes of disease and death in Ethiopia and created activities for small-scale farmers to address these problems. We found that several diseases caused diarrhea and respiratory infections in young calves in Ethiopia. Improving farmer knowledge and behaviors with respect to basic livestock management led to considerable reductions in young livestock disease and death and has the potential to help improve livestock productivity and human livelihoods in Ethiopia. ABSTRACT: Morbidity and mortality of young stock present economic and production challenges to livestock producers globally. In Ethiopia, calf morbidity and mortality rates, particularly due to diarrhea and respiratory disease, are high, limiting production, incomes, and the ability of farmers to improve their livelihoods. In this paper, we present findings from the combined experience of the Young Stock Mortality Reduction Consortium, which conducted epidemiological and intervention testing in calves across three production systems. This innovative alliance identified Cryptosporidium parvum and E. Coli K99 as the most common causes of diarrhea in pastoral and peri-urban calves; Strongyloides spp. as the most common fecal parasite in mixed crop–livestock and peri-urban calves; and bovine adenovirus, parainfluenza virus-3, and bovine respiratory syncytial virus as the most common respiratory pathogens in peri-urban calves. Furthermore, by improving producer knowledge with respect to fundamental livestock husbandry, feeding, housing, and neonatal care practices, calf mortality risk across production systems was reduced by 31.4 to 71.4% compared to baseline (between 10.5 and 32.1%), whereas risk of diarrhea was reduced by 52.6–75.3% (baseline between 11.4 and 30.4%) and risk of respiratory disease was reduced by 23.6–80.8% (baseline between 3.3 and 16.3%). These findings have informed scaling strategies and can potentially contribute to improved livestock productivity and human livelihoods in Ethiopia

Rapid Plant Identification Using Species- and Group-Specific Primers Targeting Chloroplast DNA

Plant identification is challenging when no morphologically assignable parts are available. There is a lack of broadly applicable methods for identifying plants in this situation, for example when roots grow in mixture and for decayed or semi-digested plant material. These difficulties have also impeded the progress made in ecological disciplines such as soil- and trophic ecology. Here, a PCR-based approach is presented which allows identifying a variety of plant taxa commonly occurring in Central European agricultural land. Based on the trnT-F cpDNA region, PCR assays were developed to identify two plant families (Poaceae and Apiaceae), the genera Trifolium and Plantago, and nine plant species: Achillea millefolium, Fagopyrum esculentum, Lolium perenne, Lupinus angustifolius, Phaseolus coccineus, Sinapis alba, Taraxacum officinale, Triticum aestivum, and Zea mays. These assays allowed identification of plants based on size-specific amplicons ranging from 116 bp to 381 bp. Their specificity and sensitivity was consistently high, enabling the detection of small amounts of plant DNA, for example, in decaying plant material and in the intestine or faeces of herbivores. To increase the efficacy of identifying plant species from large number of samples, specific primers were combined in multiplex PCRs, allowing screening for multiple species within a single reaction. The molecular assays outlined here will be applicable manifold, such as for root- and leaf litter identification, botanical trace evidence, and the analysis of herbivory