Non-communicable Diseases in Ethiopia: Disease burden, gaps in health care delivery and strategic directions.

Abstract Introduction: In Ethiopia, non-communicable diseases (NCDs) cause 42% of deaths, of which 27% are premature deaths before 70 years of age. The Disability Adjusted Life Years (DALYs) increased from below 20% in 1990 to 69% in 2015. With no action, Ethiopia will be the first among the most populous nations in Africa to experience dramatic burden of premature deaths and disability from NCDs by 2040. However, the national response to NCDs remains fragmented with the total health spending per capita for NCDs still insignificant. The focus of this paper is highlighting the burden of NCDs in Ethiopia and analyzing one of the two major WHO recommended policy issues; the status of integrated management of NCDs, in Ethiopia. NCDs are complex conditions influenced by a range of individual, social and economic factors, including our perceptions and behavior. Also, NCDs tend to be easily overlooked by individuals and policy makers due to their silent nature. Thus, effectively addressing NCDs requires a fresher look into a range of health system issues, including how health services are organized and delivered.Methods: A mixed method approach with quantitative and qualitative data was used. Quantitative data was obtained through analysis of the global burden of diseases study, WHO-STEPs survey, Ethiopian SARA study and the national essential NCD drug survey. This was supplemented by qualitative data through review of a range of documents, including the national NCD policies and strategies and global and regional commitments.Results and discussion: In 2015, NCDs were the leading causes of age-standardized death rate (causing 711 deaths per 100,000 people (95% UI: 468.8–1036.2) and DALYs. The national estimates of the prevalence of NCD metabolic risk factors showed high rates of raised blood pressure (16%), hyperglycemia (5.9%), hypercholesterolemia (5.6%), overweight (5.2%) and Obesity (1.2%). Prevalence of 3-5 risk factors constituting a metabolic syndrome was 4.4%. Data availability on NCD morbidity and mortality is limited. While there are encouraging actions on NCDs in terms of political commitment, lot of gaps as shown by limited availability of resources for NCDs, NCD prevention and treatment services at the primary health care (PHC) level. Shortage of essential NCD drugs and diagnostic facilities and lack of treatment guidelines are major challenges. There is a need to re-orient the national health system to ensure recognition of the NCD burden and sustain political commitment, allocate sufficient funding and improve organization and delivery of NCD services at PHC level. [Ethiop. J. Health Dev. 2018;32 (3):00-000]Key words: Non-communicable diseases, health-system re-orientation, NCD burden, metabolic risk factors, Service delivery, Primary Health Car

Feasibility study of a solar photovoltaic water pumping system for rural Ethiopia

Solar Photovoltaic (SPV) water pumping system is one of the best technologies that utilize the solar energy to pump water from deep well underground water sources and to provide clean drinking water worldwide. The availability of abundant solar radiation and enough underground water sources in Ethiopia can be combined together to make clean drinking water available to rural communities. The software PVsyst 5.56 was used to study the feasibility of solar photovoltaic water pumping system in the selected sites. The designed system is capable of providing a daily average of 10.5, 7 and 6.5 m3/day for 700, 467 and 433 people in Siadberand Wayu, Wolmera and Enderta sites respectively, with average daily water consumption of 15 liters per day per person and the costs of water without any subsidy, are approximately 0.1, 0.14 and 0.16 $/m3for each site respectively. If diesel generator is used instead of solar photovoltaic water pumping system, to provide the same average daily water for the selected community, the costs of water without any subsidy are approximately 0.2, 0.23 and 0.27$/m3 for each site respectively. A life cycle cost analysis method was also carried out for economic comparison between solar PV and the diesel pumping system. The results of this study are encouraging the use of the PV system for drinking water supply in the remote areas of the country

Feasibility study of a wind powered water pumping system for rural Ethiopia

Water is the primary source of life for mankind and one of the most basic necessities for rural development. Most of the rural areas of Ethiopia do not have access to potable water. Is some regions of the country access potable water is available through use of manual pumping and Diesel engine. In this research, wind water pump is designed to supply drinking water for three selected rural locations in Ethiopia. The design results show that a 5.7 m diameter windmill is required for pumping water from borehole through a total head of 75, 66 and 44 m for Siyadberand Wayu, Adami Tulu and East Enderta to meet the daily water demand of 10, 12 and 15 m3, respectively. The simulation for performance of the selected wind pump is conducted using MATLAB software and the result showed that monthly water discharge is proportional to the monthly average wind speed at the peak monthly discharge of 685 m3 in June, 888 m3 in May and 1203 m3 in March for Siyadberand Wayu, Adami Tulu and East Enderta sites, respectively. An economic comparison is conducted, using life cycle cost analysis, for wind mill and Diesel water pumping systems and the results show that windmill water pumping systems are more feasible than Diesel based systems

Road traffic deaths and injuries are under-reported in Ethiopia: a capture-recapture method.

In low and middle income countries road traffic injuries are commonly under-reported. This problem is significantly higher among those less severely injured road users. The objective of this study was to determine the incidence and the level of ascertainment of road traffic injuries and deaths by traffic police and hospital registry. In this study two-sample capture-recapture method was applied using data from traffic police and hospital injury surveillance, through June 2012 to May 2013. The study was conducted on one of the busiest highways in Ethiopia, the Addis Ababa - Hawassa highway. Primary data were collected by accident investigators and hospital emergency nurses using a structured checklist. Four matching variables; name of the victim, sex, place and time of the accidents was used to get the matched cases. During the study period the police independently reported 224 deaths and 446 injuries/billion vehicle kilometer while hospitals reported 123 deaths and 1,046 injuries/billion vehicle kilometer. Both sources in common captured 73 deaths and 248 injuries/billion vehicle kilometer. Taking the two data sources into consideration, the capture-recapture model estimated the incidence of deaths and injuries ranged 368-390 and 1,869-1,895 per billion vehicle kilometer, respectively. The police source captured 57.4%-60.9% of deaths and 23.5%-23.9% of injuries while the hospital sources captured 31.5%-33.4% of deaths and 55.2%-56% of injuries. Deaths and injuries among females, younger age victims, cyclists/motorcyclists and pedestrians were under-reported by traffic police. In conclusion neither of the two sources independently provided accurate coverage of road traffic incident related deaths and injuries. Strengthening both systems is necessary to obtain accurate information on road accidents and human causalities

Factors associated with late Human Immunodeficiency Virus (HIV) diagnosis among peoples living with it, Northwest Ethiopia: hospital based unmatched case-control study

Abstract Background Early HIV diagnosis and access to treatment is one of the most effective ways to prevent its further spread and to protect the health of those living with the virus. However, delay in diagnosis is the major risk factor for uptake of and response to antiretroviral therapy. Methods Institution-based unmatched case-control study design was used in the study. The study was conducted in Debre-Markos and Finote-Selam Hospitals, Northwest Ethiopia. Cases were people living with HIV who had CD4 count <350cells/mm3 or WHO clinical stage III and IV regardless of the CD4 count at first presentation and controls were those who had CD4 count ≥350cells/mm3 or WHO clinical stage I and II. If both criteria were available, the CD4 count was used in the study as World Health Organization recommended. A total of 392 respondents (196 cases and 196 controls) were recruited and selected systematically. The data were collected by trained nurses using chart review and interviewer administered structured questionnaire. Binary Logistic Regression Model was used to identify the factors associated with late HIV diagnosis. Results About 95.9 % of study participants provided complete response. Having no understanding, compared to having understanding, about HIV/AIDS (AOR = 1.7, 95 %CI = 1.08–2.79) and ART (AOR = 2.1, 95 %CI: 1.25–3.72), being tested as a result of symptoms/ illness, compared to being tested for risk exposure (inverted AOR =2.5, 95 %CI: 1.64–4.76), and acquiring HIV through sexual contact, compared to acquiring it through other modes (AOR = 2.5, 95 %CI = 1.52–4.76) were positively and independently associated with late HIV diagnosis. Conclusions Unlike perceived HIV stigma, having no understanding about HIV and ART, being tested for presence of symptoms/illness, and acquiring HIV through sexual contact were independent and significant factors for late HIV diagnosis

Stratified capture-recapture estimates of injuries on the Addis Ababa- Hawassa highway, Ethiopia, June 2012–May 2013.

<p>Stratified capture-recapture estimates of injuries on the Addis Ababa- Hawassa highway, Ethiopia, June 2012–May 2013.</p