Knowledge, Attitude and Practice of Trained Traditional Birth Attendants on HIV/AIDS Prevention in Jimma Town, Southwest Ethiopia

Background: HIV/AIDS is a global pandemic with cases being reported from virtually every country in the world. There is a growing awareness in many African countries that trained traditional birth attendants have a major role to play in HIV/AIDS prevention. However, information on their knowledge, attitude and practice concerning prevention of the disease is scarce. Therefore, this study was designed to assess their knowledge, attitude and practice and document baseline data for the study area. Methods: A cross-sectional survey was conducted from October 25 to 30, 1999 on all the 30 trained traditional birth attendants serving in Jimma town in order to assess their knowledge, attitude and practice in the prevention of HIV/AIDS. A pre-tested, structured questionnaire was used to collect the data. Attitude was measured using a Likert scale. Results: All the 30 trained traditional birth attendants responded making a response rate of 100%. The study revealed that the majority, 17/30 (56.7%) were above the ages 50 years (mean +SD = 54 + 10), Christians, 19/30(63.3%), oromo, 11/36 (36.7%) and illiterate, 21/30(70%). It also showed that 70%, 80% and 70% of the study population had “good knowledge”, “favorable attitude” and “ safe practice”, respectively. However, 26.7% and 60% responded that shaking hands with AIDS patients and insect bite respectively were considered to be risky to transmit HIV infection by of the study population. Moreover, majority (60%) feels that AIDS patients should be isolated and 23.3 % reported to assist delivery bare handed. Health institutions and radio were reported to be the main sources of information on HIV/AIDS. Conclusion: Although majority of the study population does have good knowledge, favorable attitude and safe practice, there are some misconceptions on the modes of transmission of HIV/AIDS. Moreover, the majority is in favor of isolation of AIDS patients and some are practicing unsafely. Therefore, series of refreshment courses on the ways and means of HIV/AIDS transmission and prevention and safe delivery practices are recommended. Further large-scale study is also recommended.Ethiop J Health Sci Vol. 11, No. 2 July 200

Leadership in strategic information (LSI) building skilled public health capacity in Ethiopia

<p>Abstract</p> <p>Background</p> <p>In many developing countries, including Ethiopia, few have the skills to use data for effective decision making in public health. To address this need, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with two local Ethiopian organizations, developed a year long Leadership in Strategic Information (LSI) course to train government employees working in HIV to use data from strategic information sources. A process evaluation of the LSI course examined the impact of the training on trainees' skills and the strengths and weaknesses of the course. The evaluation consisted of surveys and focus groups.</p> <p>Findings</p> <p>Trainees' skill sets increased in descriptive and analytic epidemiology, surveillance, and monitoring and evaluation (M and E). Data from the evaluation indicated that the course structure and the M and E module required revision in order to improve outcomes. Additionally, the first cohort had a high attrition rate. Overall, trainees and key stakeholders viewed LSI as important in building skilled capacity in public health in Ethiopia.</p> <p>Conclusion</p> <p>The evaluation provided constructive insight in modifying the course to improve retention and better address trainees' learning needs. Subsequent course attrition rates decreased as a result of changes made based on evaluation findings.</p

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Effect of degraded land rehabilitation on carbon stocks and biodiversity in semi-arid region of Northern Ethiopia

This study evaluated the effects of exclsoures (EXs) on restoring woody species diversity and carbon stocks over the adjacent degraded open grazing land (DOGL). Two proximate sites were purposively selected. Then, systematic sampling method was employed. A total of sixty plots were surveyed for both tree/shrub inventory and soil sampling purposes. Overall, 49 woody species belonging to 45 genera and 28 families were identified, it comprising 46 woody species in the EX and 26 woody species in the DOGL. Species richness, Shannon and Simpson diversity indices were significantly higher in the EXs than DOGL. The total carbon stock was significantly higher in EXs (61.3 Mg C ha−1, it ranged from 54.3 to 68.3 Mg C ha−1) than DOGL (40.4 Mg C ha−1, it ranged from 35.1 to 45.7 Mg C ha−1). The conversion of the DOGL to EXs enhanced soil organic carbon and aboveground biomass carbon stock by 38 and 197% at the age of 12 years, respectively. Woody species diversity, abundance and richness were positively correlated with biomass and soil organic carbon stocks. This study revealed that EXs assisted with enrichment planting can be considered as a viable woody species recovery and carbon sequestration strategy. Abbreviations: EXs: Exclosures; DOGL: Degraded open grazing land: REDD+: Reduce Emissions from Deforestation and Forest degradation plus; SOC: Soil organic carbon; dbh: Diameter at breast height; AGB: Aboveground biomass; BGB: Belowground biomass

Enset (Ensete Ventricosoum) Value Chain in Dawuro Zone, Southern Ethiopia

This study was conducted in Dawuro zone southern part of Ethiopia with aim of analyzing enset value chain with specific objectives of identifying actors and their functions along the value chain, examine the share of benefits along ‘enset’ value chain, analyze factor affecting market participation and outlet choice of producer. The multi-stage sampling method was employed to select representative producers. The data were collected from both primary and secondary sources. Primary data was collected from 152 producers’ 57 traders and 66 consumers, respectively. While secondary data were collected from published and unpublished documents. Descriptive statistics, econometric models of Tobit regression and multivariate probit methods were used to analyze the data using STATA software. Participation and level of market participation were used as a dependent variable to analyze determinants of enset market participation. Market outlet choice was used as a dependent variable to investigate factor affecting outlet choice of the producer. The finding of the study revealed that major actors of the value chain are, input suppliers, enablers, enset producers, local collectors, wholesalers, retailers, and consumers. The performance of actors in value chain emphasized that about 26 % kocho and 25.95% ‘bulla’ profit margin shared by producers. Similarly, local collectors, wholesaler, and retailers have shared 27%, 22% and 25.08% of kocho; and 25.32%, 22.15% and 26.5% share of bulla margin respectively. Retailers got a high share of profit 26.5% from bulla. Moreover, local collectors get 27% share of profit from ‘kocho’. However, farmers have the lowest share of profit margin (26%) since local collectors and wholesalers govern the chain. the econometric result revealed that distance to nearest market at 10%, family size10% and incidence of the disease at 5% determined the probability of farmer’s market participation negatively and significantly. Education level 1%, quantity produced at 1%, consumer preference at 1%, transport facility at 1% and Price at 1% is determining the market participation of the producer positively and significantly. The result of multivariate probit model indicated that the outlet choices have significantly influenced by age of producer, education level, and distances to market, extension contact, packing animal owner, labor availability, output produced and price of the products. Moreover, the model result indicated that the predicted probability of choosing direct-consumers outlet was (29%) which is relatively lower than collectors (44%) retailers (38%) and wholesaler outlets (69%), since they face constraints immediately to get direct consumers, the probabilities of producers jointly to choose and not to choose four outlets were 2.29% and 5.43% respectively. The Wald χ2 test value of 112.64, which is significant at 1% significance level indicating that separate estimation of choice of four outlets is biased, and the decisions to choose the four outlets are interdependent and simultaneous. Therefore, collective efforts required motivation of extension agents and linking actors with the market are recommended to increase value chain of enset product in the study area.</p