Factors Associated with Readiness to VCT Service Utilization among Pregnant Women Attending Antenatal Clinics in Northwestern Ethiopia: A Health Belief Model Approach

BACKGROUND: One of the consequences of Human Immunodeficiency Virus infection in women is the transmission of the virus to their children. Voluntary counseling and testing is an entry point for prevention of mother to child transmission). This study therefore, investigated readiness to Voluntary counseling and testing service utilization and associated factors among pregnant women attending antenatal care clinics using a health belief model. METHODS: Health institution based cross-sectional study supplemented with qualitative method was conducted at Debremarkos town from February 15 to March 25, 2008. A total of 418 Antenatal care clients were interviewed. In addition four focus group discussion and five in-depth interviews were performed. RESULTS: Out of 418 pregnant women 254(60.8%) had heard of, Voluntary counseling and testing of these 141 (55.5%) were not ready to use. R Voluntary counseling and testing eadiness of women to utilize Voluntary counseling and testing was significantly associated with knowledge on mother to child transmission, gravidity, gestational age, occupation and educational status. Most women 161 (63.4%) had low perceived susceptibility to HIV and 199(78.3%) had high perceived barrier to Voluntary counseling and testing. The qualitative result showed spouse's disapproval, fear of blood drawing and knowing HIV status, stigma and discrimination were mentioned as barriers. Among the HBM constructs, perceived susceptibility, benefit, barrier and self efficacy were important predictors of women's readiness to. Voluntary counseling and testing CONCLUSION: This study showed pregnant women's readiness to utilize is l Voluntary counseling and testing ow. It is useful hence, to implement Information Education Communication/Behavioral Change Communication strategies to increase readiness. The use of behavioral model will likely assist the intervention

Early life determinants of wheeze and allergic disease: a longitudinal study in an Ethiopian birth cohort

Background The hypothesis that paracetamol may increase the risk of asthma and other allergic disease has gained consistent support from epidemiological studies, but evidence from longitudinal cohort studies, particularly those looking at the timing and dose of exposure are lacking. Epidemiological studies have also reported an inverse relation between gastro-intestinal infections including Helicobacter pylori, commensal bacteria and geohelminths and asthma and allergic disease, however, data from longitudinal birth cohort study are scarce. This thesis has therefore investigated the effects of paracetamol, H. pylori and other gastro-intestinal infections on the incidence and prevalence of allergic diseases and sensitization in a low-income birth cohort in which confounding by social advantage and other medical interventions is unlikely to play a role. Methods In 2005/6 a population based cohort of 1065 pregnant women from Butajira, Ethiopia was established, to whom 1006 live singleton babies were born, and these children have been followed-up from birth to age five. At ages one, three and five, the International Study of Asthma and Allergies in Children (ISAAC) questionnaires were administered to the mothers to obtain data on wheeze, eczema and rhinitis. Allergen skin tests to Dermatophagoides pteronyssinus and cockroach were performed at ages three and five. Data on child's use of paracetamol, and various early life putative risk factors, including levels of Der p 1 and Bla g 1 allergen in the child's bedding and symptoms of respiratory tract infections were also measured. Stool samples were collected at ages three and five for analysis of H. pylori antigen using a rapid test (Medimar immunocard), as well as for geohelminths (at ages one, three and five) and selected commensal bacteria (at age three). Multivariate logistic regression was used to determine the independent effects of various markers of paracetamol use on the incidence of each outcome between age one and five, as well as on prevalence at age five. Similar analyses were also carried out to determine the independent effects of H. pylori, geohelminths and commensals on the incidence and prevalence of each outcome. Results Effects of paracetamol Of the 1006 children in the cohort at birth, 863 children were successfully followed up at age five (94% of surviving mother-child dyads). Wheeze and eczema incidence between the ages of one and five were reported in 5.9% (40/676) and 5.8% (39/700) of children respectively, and rhinitis and sensitization incidence between ages three and five were found in 3.9% (31/798) and 2.0% (15/766) of children respectively. Paracetamol use in the first three years of life was common, with 18% reported use at age one but not three, 23% at age three but not one and 21% at both time points. Use in the first year of life was significantly associated with a dose-dependent increased risk of incident wheeze between ages one and three (fully adjusted ORs, 95% CI, 1.77; 0.96, 3.26 for 1-3 tablets and 6.78; 1.89, 24.39 for ..?. 4 tablets in past month versus never), but not eczema. The risk of incident wheeze, eczema, rhinitis and sensitization between ages three and five was increased in those exposed, significantly so for incident eczema (p=0.02) and borderline significant for rhinitis (p=0.07), with fully adjusted odds ratios (ORs), including for symptoms of respiratory tract infections, for persistent exposure (ages one and three) versus never of 3.82 (95% CI 1.36, 10.73) and 3.10 (1.00, 9.57) respectively. Borderline significant trends were also seen between paracetamol dose in the first three years of life and incident eczema and rhinitis, with adjusted ORs for heavy reported use compared to low of 1.59 (0.44, 5.74; p trend=0.06) and 2.31 (0.72, 7.46; p trend=0.07) respectively, but not with incident wheeze (fully adjusted OR=3.64; 1.34, 9.90, p trend=0.11). Cross-sectional analysis at age five resulted in significant positive dose-response effects of lifetime use (use at ages one, three and five) in relation to the prevalence of all outcomes. Effects of gastro-intestinal infection H. pylori infection was found in 17% of the children at age three but not five, 21% at age five but not three years, and 25% at both ages. In the longitudinal analysis, H. pylori infection at age three was significantly associated with a decreased risk of incident eczema between ages three and five years (adjusted OR, 95% CI, 0.31; 0.10, 0.94, p=0.02), but the associations with incident wheeze, rhinitis and sensitization were not significant. In cross-sectional analysis at age three, H. pylori infection was associated with a borderline significant reduced risk of eczema (adjusted OR, 95% CI, 0.49; 0.24, 1.01, p=0.05) and D. pteronyssinus sensitization (adjusted OR, 95% CI, 0.42; 0.17, 1.08, p=0.07), and a significant inverse association between current exposure to H. pylori, and any sensitization at age five (adjusted OR, 95% CI, 0.26; 0.07, 0.92, p=0.02). However, no significant associations were seen for wheeze and rhinitis. The prevalence and intensity of geohelminth infection (hookworm, Ascaris lumbricoides and Trichuris trichiura) were found to be low in this cohort, with only 4% of children infected at age one, 9% at age three and only 0.2% at both ages. The risk of new onset wheeze between ages one and three was lower in those infected at age one (3.6%) than uninfected (7.8%), but infection was insufficiently prevalent to compute estimates of effect. Exposure to geohelminth infections in the first three years of life was not significantly associated with the incidence of reported outcomes or sensitization. However, A. lumbricoides infection was associated with a borderline increased risk of incident eczema between ages three and five (adjusted OR, 95% CI, 2.86; 1.04, 7.86, p=0.07). Children at age three were commonly colonized with enterococci 38% (207/544), lactobacilli 31% (169/544) and bifidobacteria 19% (103/544). However, none of these commensal bacteria were associated significantly with either incidence or prevalence of allergic outcomes. Conclusions This longitudinal study from a developing country birth cohort provides further support for an association between early life use of paracetamol and increased risk of wheeze and allergic disease, which is unlikely to be explained by aspirin avoidance, reverse causation or confounding by indication. Furthermore, among young children in this cohort, the study found novel evidence to support the hypothesis of a protective effect of H. pylori infection on the risk of allergic disease, but no evidence to support an etiological role for the microflora enterococci, lactobacilli or bifidobacteria. The power of the study to explore the role of geohelminth infection on wheeze and allergic disease was limited by few infected children, and therefore understanding on this particular relation has not been much further advanced

Early life determinants of wheeze and allergic disease: a longitudinal study in an Ethiopian birth cohort

Background The hypothesis that paracetamol may increase the risk of asthma and other allergic disease has gained consistent support from epidemiological studies, but evidence from longitudinal cohort studies, particularly those looking at the timing and dose of exposure are lacking. Epidemiological studies have also reported an inverse relation between gastro-intestinal infections including Helicobacter pylori, commensal bacteria and geohelminths and asthma and allergic disease, however, data from longitudinal birth cohort study are scarce. This thesis has therefore investigated the effects of paracetamol, H. pylori and other gastro-intestinal infections on the incidence and prevalence of allergic diseases and sensitization in a low-income birth cohort in which confounding by social advantage and other medical interventions is unlikely to play a role. Methods In 2005/6 a population based cohort of 1065 pregnant women from Butajira, Ethiopia was established, to whom 1006 live singleton babies were born, and these children have been followed-up from birth to age five. At ages one, three and five, the International Study of Asthma and Allergies in Children (ISAAC) questionnaires were administered to the mothers to obtain data on wheeze, eczema and rhinitis. Allergen skin tests to Dermatophagoides pteronyssinus and cockroach were performed at ages three and five. Data on child's use of paracetamol, and various early life putative risk factors, including levels of Der p 1 and Bla g 1 allergen in the child's bedding and symptoms of respiratory tract infections were also measured. Stool samples were collected at ages three and five for analysis of H. pylori antigen using a rapid test (Medimar immunocard), as well as for geohelminths (at ages one, three and five) and selected commensal bacteria (at age three). Multivariate logistic regression was used to determine the independent effects of various markers of paracetamol use on the incidence of each outcome between age one and five, as well as on prevalence at age five. Similar analyses were also carried out to determine the independent effects of H. pylori, geohelminths and commensals on the incidence and prevalence of each outcome. Results Effects of paracetamol Of the 1006 children in the cohort at birth, 863 children were successfully followed up at age five (94% of surviving mother-child dyads). Wheeze and eczema incidence between the ages of one and five were reported in 5.9% (40/676) and 5.8% (39/700) of children respectively, and rhinitis and sensitization incidence between ages three and five were found in 3.9% (31/798) and 2.0% (15/766) of children respectively. Paracetamol use in the first three years of life was common, with 18% reported use at age one but not three, 23% at age three but not one and 21% at both time points. Use in the first year of life was significantly associated with a dose-dependent increased risk of incident wheeze between ages one and three (fully adjusted ORs, 95% CI, 1.77; 0.96, 3.26 for 1-3 tablets and 6.78; 1.89, 24.39 for ..?. 4 tablets in past month versus never), but not eczema. The risk of incident wheeze, eczema, rhinitis and sensitization between ages three and five was increased in those exposed, significantly so for incident eczema (p=0.02) and borderline significant for rhinitis (p=0.07), with fully adjusted odds ratios (ORs), including for symptoms of respiratory tract infections, for persistent exposure (ages one and three) versus never of 3.82 (95% CI 1.36, 10.73) and 3.10 (1.00, 9.57) respectively. Borderline significant trends were also seen between paracetamol dose in the first three years of life and incident eczema and rhinitis, with adjusted ORs for heavy reported use compared to low of 1.59 (0.44, 5.74; p trend=0.06) and 2.31 (0.72, 7.46; p trend=0.07) respectively, but not with incident wheeze (fully adjusted OR=3.64; 1.34, 9.90, p trend=0.11). Cross-sectional analysis at age five resulted in significant positive dose-response effects of lifetime use (use at ages one, three and five) in relation to the prevalence of all outcomes. Effects of gastro-intestinal infection H. pylori infection was found in 17% of the children at age three but not five, 21% at age five but not three years, and 25% at both ages. In the longitudinal analysis, H. pylori infection at age three was significantly associated with a decreased risk of incident eczema between ages three and five years (adjusted OR, 95% CI, 0.31; 0.10, 0.94, p=0.02), but the associations with incident wheeze, rhinitis and sensitization were not significant. In cross-sectional analysis at age three, H. pylori infection was associated with a borderline significant reduced risk of eczema (adjusted OR, 95% CI, 0.49; 0.24, 1.01, p=0.05) and D. pteronyssinus sensitization (adjusted OR, 95% CI, 0.42; 0.17, 1.08, p=0.07), and a significant inverse association between current exposure to H. pylori, and any sensitization at age five (adjusted OR, 95% CI, 0.26; 0.07, 0.92, p=0.02). However, no significant associations were seen for wheeze and rhinitis. The prevalence and intensity of geohelminth infection (hookworm, Ascaris lumbricoides and Trichuris trichiura) were found to be low in this cohort, with only 4% of children infected at age one, 9% at age three and only 0.2% at both ages. The risk of new onset wheeze between ages one and three was lower in those infected at age one (3.6%) than uninfected (7.8%), but infection was insufficiently prevalent to compute estimates of effect. Exposure to geohelminth infections in the first three years of life was not significantly associated with the incidence of reported outcomes or sensitization. However, A. lumbricoides infection was associated with a borderline increased risk of incident eczema between ages three and five (adjusted OR, 95% CI, 2.86; 1.04, 7.86, p=0.07). Children at age three were commonly colonized with enterococci 38% (207/544), lactobacilli 31% (169/544) and bifidobacteria 19% (103/544). However, none of these commensal bacteria were associated significantly with either incidence or prevalence of allergic outcomes. Conclusions This longitudinal study from a developing country birth cohort provides further support for an association between early life use of paracetamol and increased risk of wheeze and allergic disease, which is unlikely to be explained by aspirin avoidance, reverse causation or confounding by indication. Furthermore, among young children in this cohort, the study found novel evidence to support the hypothesis of a protective effect of H. pylori infection on the risk of allergic disease, but no evidence to support an etiological role for the microflora enterococci, lactobacilli or bifidobacteria. The power of the study to explore the role of geohelminth infection on wheeze and allergic disease was limited by few infected children, and therefore understanding on this particular relation has not been much further advanced

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

Burden assessment of podoconiosis in Wayu Tuka woreda, east Wollega zone, western Ethiopia: a community-based cross-sectional study

Objective Podoconiosis is a neglected tropical disease characterised by a slowly progressive swelling of the foot and lower leg. It is prevalent among subsistence barefoot farmers who live and work in highland areas of the tropics. This study was conducted in Wayu Tuka ‘woreda’ (district), western Ethiopia to determine the prevalence of podoconiosis and assess factors associated with acute adenolymphangitis (ALA) episodes. Methods and analysis A two phase, community-based cross-sectional study was conducted between January and March 2015. First, all households in the district were surveyed to determine the prevalence of podoconiosis. This was followed by a second phase in which 366 people with podoconiosis from four randomly selected ‘kebeles’ (subdistricts) were assessed for clinical features of the disease, shoe-wearing habits, personal hygiene, social stigma and functional impairment. Data entered into Epi DATA were then exported to SPSS. Logistic regression analysis was conducted to identify factors associated with ALA. Results Prevalence of podoconiosis in the population was 3.05% (1197/39 256) (95% CI 2.9% to 3.2%). The prevalence was significantly higher among women than men (3.67% vs 2.4%). Most (92.2%) people with podoconiosis were in the economically active age group (15–64 years) in the first phase survey. Of participants in the second phase of the study, 43% had stage 2 disease and 38.1% had ‘moss’-like skin changes. On average, people with podoconiosis had 23.3 episodes of ALA/year and each person with podoconiosis lost 149.5 days of activity/year. Never walking barefoot and daily foot washing were both associated with decreased odds of ALA (AOR=0.23; 95% CI 0.06 to 0.80 and 0.09; 95% CI 0.01 to 0.75, respectively). Conclusions A relatively high prevalence of podoconiosis, frequent ALA episodes and considerable decreases in daily activities were identified in this district. Footwear use and daily foot hygiene were associated with decreased odds of ALA. We recommend prevention and morbidity management interventions to address this developmental challenge

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

Uptake and barriers of voluntary counseling and testing among antenatal care attendants, southwest Ethiopia

BACKGROUND . Voluntary counseling and testing (VCT) service provides an essential knowledge, skill and helps pregnant women to access intervention such as short course antiretroviral and infant feeding options. Therefore, the potential barriers to the service need to be assessed. OBJECTIVE: This study is intended to examine the uptake of VCT and its barrier among Antenatal care (ANC) attendants in southwest Ethiopia. METHODS- Health institution based cross-sectional study was conducted from Sept. 1. 2004 to Nov. 1, 2004 a mong ANC attendants in southwest Ethiopia. A total of 285 pregnant women were selected conveniently. Additionally, five experienced counselors were involved in the study. Both qualitative and quantitative interviews methods were utilized using structured questionnaires. RESULT-Out of a total of 285 pregnant women who participated in the study, 77(27% had decepted VCT. The acceptance rate was higher among 16-20 years old women (p<0.05) and those from urban résidences (p<0.025). Women who are single, divorced or widowed were also found to have more acceptance of VCT than married women (P<0.001). Among tested women 61(79.2%) received test result. Qualitative analysis showed that I ack of decision-making a utonomy and fear of partner's reactions were identified as major barriers. The reason for low return for test result was the women do not want to know their HIV status; but gave their blood to avoid offending the counselors. CONCLUSION - This study revealed that the uptake of VCT service is very low. Therefore, to increase the utilization of VCT service at ANC setting, problems associated with the service should be addressed. This includes quality of counseling, provision of test result on same day and addressing individual concerns

Frequent use of paracetamol and risk of allergic disease among women in an Ethiopian population

Introduction The hypothesis that paracetamol might increase the risk of asthma and other allergic diseases have gained support from a range of independent studies. However, in studies based in developed countries, the possibility that paracetamol and asthma are associated through aspirin avoidance is difficult to exclude. Objectives To explore this hypothesis among women in a developing country, where we have previously reported aspirin avoidance to be rare. Methods In 2005/6 a population based cohort of 1065 pregnant women was established in Butajira, Ethiopia and baseline demographic data collected. At 3 years post birth, an interview-based questionnaire administered to 945 (94%) of these women collected data on asthma, eczema, and hay fever in the past 12 month, frequency of paracetamol use and potential confounders. Allergen skin tests to Dermatophagoides pteronyssinus and cockroach were also performed. The independent effects of paracetamol use on allergic outcomes were determined using multiple logistic regression analysis. Findings The prevalence of asthma, eczema and hay fever was 1.7%, 0.9% and 3.8% respectively; of any one of these conditions 5.5%, and of allergen sensitization 7.8%. Paracetamol use in the past month was reported by 29%, and associations of borderline significance were seen for eczema (adjusted OR (95% CI) = 8.51 (1.68 to 43.19) for 1–3 tablets and 2.19 (0.36 to 13.38) for ≥4 tablets, compared to no tablets in the past month; overall p = 0.055) and for ‘any allergic condition’ (adjusted OR (95% CI) = 2.73 (1.22 to 6.11) for 1–3 tablets and 1.35 (0.67 to 2.70) for ≥4 tablets compared to 0 in the past month; overall p = 0.071). Conclusions This study provides further cross-sectional evidence that paracetamol use increases the risk of allergic disease

‘Why should I worry, since I have healthy feet?’ A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia

Objective To explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia. Design A qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides. Setting The study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia. Participants A total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including Idir (a form of social insurance) leaders, school principals, kebele (the lowest administrative unit) officials, health professionals, teachers, merchants and religious leaders; (2) affected men and women; (3) non-affected men and women not in leadership positions; and (4) school children (both male and female). Results Participants perceived a range of health benefits from donning footwear, including protection against injury and cold. Various types of shoes are available within the community, and their use varied depending on the nature of activities and the season. Personal and socioeconomic barriers hindered the desire to consistently use footwear. Widely established barefoot traditions and beliefs that footwear is uncomfortable, heavy and may weaken the feet have made the regular use of footwear uncommon. Economic constraints were also mentioned as hindering ownership and use of footwear. Distance from places where shoes could be bought also contributed to limited access. Cultural influences promoting gender inequality resulted in women being least able to access shoes. Conclusions We identified several individual, cultural and socioeconomic barriers that influence individuals’ decisions about and use of footwear in rural northern Ethiopia. Promoting education on the health benefits of footwear, curbing podoconiosis-related misconceptions and integrating these with economic empowerment programmes, may all improve the use of footwear

Willingness to pay for footwear, and associated factors related to podoconiosis in northern Ethiopia

Background: In Northern Ethiopia, use of footwear by the rural community is limited, and non-governmental organizations provide footwear for school children as a means of preventing podoconiosis. However, this is not a sustainable strategy. This study assessed willingness to pay for footwear among people with and without podoconiosis. Methods: A comparative cross-sectional community-based study was conducted in Mecha and Gozamen woredas among randomly selected people with and without podoconiosis. Trained health extension workers collected data using an interviewer-administered structured questionnaire. The data were entered into EPI-Data and exported to SPSS version 16.0 statistical software package for analysis. Results: The willingness to pay for footwear among people with and without podoconiosis was 72.3% and 76.7% respectively (p=0.30). People with podoconiosis in the lower quintiles of economic status were less likely to be willing to pay for footwear than those in the higher quintiles. Conclusions: There is substantial willingness to pay for footwear. The expressed willingness to pay indicates demand for footwear in the community, suggesting an opportunity for shoe companies. There are still a substantial proportion of individuals not willing to pay for footwear. This requires intensified public education and social transformation to bring about change in behavior towards footwear use if elimination of podoconiosis within our generation is to be achieved