Tax-benefit microsimulation: Feasibility study in Ethiopia

The purpose of this study is to assess the feasibility of building a microsiumlation model of the Ethiopian tax and benefits system. We first provide a detailed describtion of the tax and benefits system of the country. This includes qualifying criteria, tax brakcets, and exemptions. We then describe household survey datasets available in the country and examine the nature of these datasets in terms of representativeness, completeness, and panel data structure. Finally, we provide assessments for whether each tax and benefits system can be microsimulatd given the rules and the nature of the data available

Low-cost wearable multichannel surface EMG acquisition for prosthetic hand control

Prosthetic hand control based on the acquisition and processing of surface electromyography signals (sEMG) is a well-established method that makes use of the electric potentials evoked by the physiological contraction processes of one or more muscles. Furthermore intelligent mobile medical devices are on the brink of introducing safe and highly sophisticated systems to help a broad patient community to regain a considerable amount of life quality. The major challenges which are inherent in such integrated system’s design are mainly to be found in obtaining a compact system with a long mobile autonomy, capable of delivering the required signal requirements for EMG based prosthetic control with up to 32 simultaneous acquisition channels and – with an eye on a possible future exploitation as a medical device – a proper perspective on a low priced system. Therefore, according to these requirements we present a wireless, mobile platform for acquisition and communication of sEMG signals embedded into a complete mobile control system structure. This environment further includes a portable device such as a laptop providing the necessary computational power for the control and a commercially available robotic handprosthesis. Means of communication among those devices are based on the Bluetooth standard. We show, that the developed low cost mobile device can be used for proper prosthesis control and that the device can rely on a continuous operation for the usual daily life usage of a patient

Can ICTs Increase Tax? Experimental Evidence from Ethiopia

The widespread introduction of information and communication technologies (ICTs) and digitalised data management systems is one of the most important developments among African tax administrations in recent years. However, very little evidence is available on their effectiveness in practice, and how taxpayers respond to these changes. This paper starts filling this gap by reporting three sets of results from Ethiopia.DFIDBill and Melinda Gates Foundatio

The prevalence and antimicrobial responses of Shigella isolates in HIV-1 infected and uninfected adult diarrhoea patients in north west Ethiopia

Background: Shigella is one of the diarrhoea causing organisms found in HIV positive patients. But so far, the pattern of diarrhoeal agents caused by Shigella in AIDS patients has not been determined. Objective: This study is thus aimed at determining the prevalence, antimicrobial susceptibility and resistance of Shigella isolates in HIV positive subjects. Methods: All stool samples taken from the subjects of this study were plated on the MacConkey agar and incubated at 35-37oC for 24 or 48 hrs. Biochemical and antimicrobial sensitivity testing were carried out by using the standard methods. Results: Out of the 391 subjects included in the study, 199(63.8%) HIV seropositive and 113 seronegative patients had acute and chronic diarrhoea while 79 were HIV seropositive without diarrhoea. Of the 27 (8.7) Shigella isolates taken from the diarrhea patients, 11 (3.5%) were from HIV positive subjects. All Shigella isolates were found to be sensitive against norfloxacin (100%), gentamicin (97%), polymyxin B (97%) and kanamycin (93%). The most frequent resistance observed was to chloramphenicol (62%), tetracycline (86%) and ampicillin (100%). The frequency of resistance of Amp, Sex, Ch, TTc was found to be very high when compared with other patterns of resistance. Conclusion: The high proportion of HIV seropositive patients who had diarrhea in the absence of identified Shigella strains strongly indicates the existence of other diarrhoeagenic agents or mechanisms. Detailed investigation is important to get comprehensive information for better treatment of diarrhoea in HIV /AIDS patients. According to this finding, norfloxacin, gentamicin, polymyxin B, kanamycin and nalidixic acid might be used as drugs of choice for empirical treatment. On the other hand, amplicilin, tetracycline and chloramphenicol may not be used as the drugs of choice for the treatment of Shigella infection unless culture and sensitivity tests are done prior to treatment. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 99-10

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Les Technologies de l’Information et de la Communication (TIC) peuvent-elles augmenter les taxes? Résultats expérimentaux en Ethiopie

This ICTD Research in Brief is a two-page summary of ICTD Working Paper 82 by Giulia Mascagni, Andualem T. Mengistu, and Firew B. Woldeyes. This series is aimed at policy makers, tax administrators, fellow researchers and anyone else who is big on interest and short on time. African tax administrations have experienced rapid modernisation in the past two decades. The digitalisation of tax records and widespread adoption of ICTs have been key features of this process. However, there is still very little evidence on the effectiveness of ICTs and digitised data on tax collection and the functioning of tax administration more broadly. In principle, ICTs can have a great impact in making the tax administration more efficient. This brief summarises the findings from the working paper that asks the empirical question of whether and to which extent these benefits can materialise in practice, in presence of severe capacity constraints within the tax administration.Résumé du document de travail 82 de Giulia Mascagni, Andualem T. Mengistu, et Firew B. Woldeyes. Les administrations fiscales africaines ont connu une rapide modernisation au cours des deux dernières décennies. La numérisation des dossiers fiscaux et l’adoption généralisée des TIC ont été des éléments majeurs de ce processus. Cependant, il y a encore très peu de preuves de l’efficacité des TIC et des données numérisées sur le recouvrement des impôts et, plus généralement, sur le fonctionnement de l’administration fiscale. En théorie, les TIC peuvent avoir un impact important sur l’augmentation de l’efficacité de l’administration fiscale et sur l’évolution des emplois de tâches mécaniques – comme la saisie des données – vers des tâches plus élaborées – comme les audits et l’analyse de données. En outre, les données numérisées peuvent rendre la mise en œuvre moins coûteuse et plus efficace, en élargissant par exemple l’utilisation des informations issues de sources tierces et par le recoupement systématique des informations des contribuables. Cet article cherche à établir de manière empirique si, et dans quelle mesure, ces avantages peuvent se matérialiser dans la pratique, en présence d’importantes contraintes de capacité au sein de l’administration fiscale

Brief communication: Low prevalence of HIV infection, and knowledge, attitude and practice on HIV/AIDS among high school students in Gondar, Northwest Ethiopia

HIV/AIDS is a major public health problem in Ethiopia. Therefore, a school based cross-sectional study was conducted in Gondar; Northwest Ethiopia to determine the seroprevalence of HIV infection and to assess Knowledge, attitude and practice related to HIV/AIDS. A total of 565 students were included in the study. The seroprevalence of HIV infection was 1.1%. Sexual contact with commercial sex worker or non-regular partner was reported by 16.7% of the students. Only 58.5% of those who practice sex used condoms. History of sexually transmitted diseases was reported by 10.7% of the sexually active students. The majority (96.6%) reported unprotected sex, unsafe blood transfusion, contaminated needles and mother to child transmissions as common ways of HIV transmission. Abstinence, faithfulness to one\'s partner and use of condom as means to prevent transmission of HIV was responded by 84.1%, 60.4% and 41.8% of the students, respectively. Over 82% demanded screening for HIV as a precondition for marriage and 97.2% agreed to have a VCT service. The findings of the study indicate that the prevalence of HIV infection is low among high school students in Gondar. The students had adequate knowledge about HIV/AIDS and VCT despite the risky practices. Continued health education is needed to bring behavioral changes.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 179-18

Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis

Human immunodeficiency virus remains a global public health problem Despite efforts to determine the prevalence of non adherence to ART and its predictors in Ethiopia various primary studies presented inconsistent findings Therefore this review aimed to determine the pooled prevalence of non adherence to ART and identify its predictors We have searched PubMed Google Scholar and Web of Science databases extensively for all available studies A weighted inverse variance random effects model was used to compute the overall non adherence to ART The pooled prevalence of non adherence to ART was 20 68 95 CI 17 74 23 61 I2 98 40 p 0 001 Educational level of primary school and lower AOR 3 5 95 CI 1 7 7 4 taking co medications AOR 0 45 95 CI 0 35 0 59 not using memory aids AOR 0 30 95 CI 0 13 0 71 depression AOR 2 0 95 CI 1 05 3 79 comorbidity AOR 2 12 95 CI 1 16 3 09 under nutrition AOR 2 02 95 CI 1 20 3 43 not believing on ART can control HIV AOR 2 31 95 CI 1 92 2 77 lack of access to health facilities AOR 3 86 95 CI 1 10 13 51 and taking ART pills uncomfortably while others looking AOR 5 21 95 CI 2 56 10 53 were significantly associated with non adherence to anti retroviral therapy The overall pooled prevalence of non adherence to ART was considerably high in Ethiopia Educational status taking co medications not using memory aids depression comorbidity under nutrition not believing on anti retroviral therapy controls HIV lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non adherence to ART in Ethiopia Therefore healthcare providers adherence counselors and supporters should detect non adherence behaviors and patients difficulties with ART early and provide intensive counseling to promote adherenc

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning