Cross-generational sexual relationship in Addis Ababa: A qualitative study

Background: Cross-generational sexual practices are considered unsafe sexual behaviors. The risk of acquiring sexually transmitted infections including HIV is believed to be high among those involved in cross-generational sexual relationship. However, studies addressing why and how people are engaged in such practices are limited. This study attempted to fill this gap. This study therefore explored cross generational sexual relationships and their perceived effects in Addis Ababa, Ethiopia.Methods: Qualitative research with a phenomenological study design was carried out in Addis Ababa, Ethiopia in 2014. Individuals who had personal experience of cross-generational sexual relationship (CGSR), and/or who were familiar with the practice were selected using snow balling technique. Six focus group discussions, three key informants and five in-depth interviews and non-participatory observations were conducted to obtain data for the study. All the FGDs and in-depth interviews were audio-recorded. The recorded data were transcribed and analyzed using a thematic approach in which motives, customs, perceived risks were separately identified for young girls and older men.Results: The motives for engaging in CGSR were found to be not the same for young girls and older men. The motives for young girls to get engaged in CGSR were often related with acquiring money and material while older men reported sexual pleasure as their driving force. The findings also revealed that cross-generational sexual relationship between a young girl and an older man did not last long. The economic background of young girls involved in such a practice was found to be mixed. This means that there were girls from poor economic background while also there were girls in the group whose economic background was fairly better off. Similarly, the educational background of the girls involved in CGSR was not found to be uniform. This means that many had either high school or college level educational background. Some in the group claimed to have completed university education. There were also illiterate young girls in the group that participated in the study. In connection with marriage, regardless of their economic background, both married and unmarried older men had this relationship. The young girls may have control on whether or not to engage themselves in CGSR. It should however be stated they either have no or little control on what would happen within relationships including the use of condom during sex. Similarly, asking for proof of HIV test before sex was also found to be a point beyond the relationship.Conclusion: Cross generational sexual relationships in Addis Ababa are likely to be unsafe due to the absence of condom use, absence of proof of HIV test before sex, and presence of multiple sexual partners. Further studies are necessary to measure the extent and effects of CGSRs. [Ethiop. J. Health Dev. 2017;31(4):228-235]Keywords: cross-generational sex, HIV, risky sexual behavior, transactional se

Polysubstance use behavior among the male population in Ethiopia: Findings from the 2016 Ethiopia Demographic and Health Survey

Background: Substance use is predominantly associated with male behavior and is becoming one of the major public health challenges across the globe, including in Ethiopia. The purpose of this study was to estimate the magnitude and predictors of polysubstance use behavior among males in Ethiopia. Methods: Data were extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). From a total of 12,688 male participants in the EDHS, a sample was extracted of 7,931 males who used at least one substance (alcohol, khat or tobacco) during the time of the survey. Those who used more than one substance were considered as polysubstance users, which was the outcome of interest. Descriptive statistics was computed and displayed with tables and graph. Logistic regression was carried out to identify predictors of polysubstance use, and statistical significance was declared at a 95% confidence level. Results: Of the total sample of 12,688 males in the 2016 EDHS, 7,931 (62.5%) were currently using at least one substance. Regional distribution of current substance users shows that Amhara (18.5%), Tigray (14.2%) and Oromia (12.8%) have the highest percentage of substance users, respectively. Among the current any substance users, 15.0% use cigarettes daily or on some days – 74.7% of these are daily users. Nineteen per cent of current male substance users in Ethiopia are polysubstance users. The main substances consumed are alcohol only (53.1%), followed by khat only (25.9%). Polysubstance use behavior can be predicted by residence (urban residence: OR: 1.78; CI: 1.35, 2.34), educational status (secondary education: OR: 1.50; CI: 1.19, 1.89) and marital status (no longer living together: OR: 2.85; CI: 1.58, 5.15). Region, religion, wealth status, age, family size and media exposure are other factors significantly associated with polysubstance use behavior. Conclusions: Polysubstance use behavior among males is widespread in all regions of the country. Socio-demographic factors and access to media are predictors of polysubstance use. Therefore, in addition to law enforcement such as prohibition of advertising, there is a need to investigate underlying genetic, structural, policy and behavioral determinants of polysubstance use so that holistic interventions can be designed to target multiple substance use simultaneously. [Ethiop. J. Health Dev. 2020; 34(3):171-180] Key words: Alcohol, cigarettes, EDHS, Ethiopia, khat, males, polysubstance use, substance us

Mental health stigma and discrimination in Ethiopia:evidence synthesis to inform stigma reduction interventions

BACKGROUND: People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.METHODS: This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.RESULTS: A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.CONCLUSION: There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia

Modern Contraceptive Use and Associated Factors among Reproductive Age Group Women in three Peri-Urban Communities in Central Ethiopia

Introduction: - Amongst the family planning program is the use of modern contraception. It is one of the key fundamentals of health services whose benefits are wellbeing’s of mothers, husbands, families, and their country in general. According to the world fertility rate report 2015, Ethiopia is expected to achieve a TFR of 2.4 children per woman between the years 2025-2030. Objective: - the principal objective of the current study was to determine the prevalence of modern contraception use and factors that affect utilization. Methods: - a quantitative community based cross-sectional study was done in three peri-urban communities of Batu, Eastern Shewa zone of Oromia region of Ethiopia from October to November 2017. A total of 351 women in the reproductive age group were interviewed with a questionnaire in the form of a house-to-house survey. Statistical analysis was done using the statistical package for social sciences (SPSS) software version 21.0. Results: - the study showed that the contraception prevalence was 37.9%. Forty-seven percent of the users were in the age group 21-29. Knowledge, formal education and religion were associated with contraception utilization. It was found that knowledge and formal education were the enhancing factors for utilization whereas the Muslim religion was an inhibiting factor for modern contraceptive use. Conclusion: - the contraceptive prevalence was higher than the national result for the rural community but lower than the urban community was. Both governmental and non-governmental organizations should continue the good work of building community awareness of modern contraceptive methods. Keywords: - Contraceptives, knowledge, attitude, practice, Bat

Female Academic Career Development and Administrative Positions at Addis Ababa University: a Mixed-Method Study

AbstractBackground: In Ethiopia, the number of female in academia in general and in administrative positions and higher university ranks in specific is very small as compared to men. A slight change has been seen in recent years, where a few women have come to male-dominated administrative positions as university presidents, vice presidents, deans and directors with still insignificant increase in the number of full professors. Objective: This study assessed female faculty member's career development and involvement in administrative positions and explored challenges. Method: We used a sequential mixed-method study starting with a cross-sectional quantitative study among 888 faculty members. The quantitate data were analysed using descriptive statistics and regression models to identify independent predictors of administrative involvement using SPSS version 25 software. An exploratory qualitative study was done among eight purposively selected female faculty. NVivo10 data management software was used to code and categorize the transcripts. Result: We found that male faculty members were more likely to involve in administrative positions than their female counterparts [AOR (95%CI) 1.6(1.1, 2.4)]. Those who were provided housing facility by AAU [AOR (95%CI) 2.29 (1.61, 3.23)] and assistant professors and above [AOR (95%CI) 1.495 (1.01, 2.220)] were more likely to involve in an administrative position than their counterparts. The qualitative findings indicated that the low salary faculty earns, lack of networks and family responsibility have deterred females from taking administrative positions. Conclusion: Female faculty involvement in the university administrative position and career development is very low. Both structural and personal factors such as gender roles affected their professional enhancement in academic ranks and hence positions. Creating a conducive platform for female faculty development is recommended to increase their involvement in administrative positions. [Ethiop. J. Health Dev. 2021; 35(SI-2):30-39]Keywords: Addis Ababa University, administrative positions, career development, female academician, female facult

Experience of Research Undertaking among Women Academia at Addis Ababa University: a Qualitative Study

AbstractBackground: As a pioneer University in the Country, Addis Ababa University engages itself in collaborative and local research undertakings along with teaching, community engagements and technology transfer. Despite its long engagement in research, the participation of women academia in research is limited as manifested by their low research productivity in terms of publication in peer-reviewed scientific journals. However, the reasons for their low research participation are less known and needs further exploration. Objective: To explore the experience of research undertakings among women academia at Addis Ababa University. Method: We conducted an exploratory qualitative study using a phenomenological approach among women academia. Eight women who have been working in the University with a rank of a lecturer having at least two years participated in in-depth interviews. We used NVivo10 software to code and categorize the transcripts. Result: Our study revealed that only a few senior informants with more than 10 years of stay at the University had a better experience in applying for national and international research grants. Although all the participants said they had ever undertaken research, their publication track in peer-reviewed journals is limited. Social and economic factors, lack of networking, low salary and family responsibility, limited internet and library access, and lack of research skill among young faculty were raised as impediments to undertake research. Conclusion: This study has indicated that women in academia had limited research engagement in terms of grant application and publication in peer reviewed scientific journals. Balancing work and family life, low salary, lack of access to common University facilities were some of the challenges. While structural change ensures gender equality at a long time, addressing the gender gap in research is the responsibility of AAU. [Ethiop. J. Health Dev. 2021; 35(SI-2):22-29]Keywords: Addis Ababa University, experience of research, women in academi

Gender Difference in Research Productivity and its Associated factors in Addis Ababa University: a Cross-Sectional study

AbstractBackground: Gender equity movements have increased the number of women going to higher institutions. However, the number of women participating in research is limited in creating a critical mass. Objective: To assess the gender gap in research and its associated factors determinants among faculty at Addis Ababa University. Method: We conducted a cross-sectional study from October 2018 to March 2019 using a structured self-administered questionnaire. University faculty who was lecturers and above level who served the University for more than a year were invited to participate in the study. Faculty were approached by data collection facilitators with graduate degrees and the secretory of the respective departments. We used descriptive and multivariate statistical methods to analyse the data. Result: Of the 888 study participants, 161 (18.1%) females faculty participated in the study. It was found that three hundred ninety-seven male academics (54.6%) and 50 female academics (31.1%) had ever published articles in peer-reviewed journals (p<0.001). Male faculty were more likely to publish in peer-reviewed journals than their female counterparts [AOR and (95% CI) [2.55 (1.68, 3.86)]. Faculty with a rank of assistant professors and above [AOR (95% CI) 3.47(2.31, 5.21)], those who have a Ph.D. as highest degree [AOR (95% CI) 2.98 (2.11, 4.19) and those who have affiliation with other institutions [AOR (95% CI) 2.59 (1.98, 3.56)], were more likely to publish in peer-reviewed journals than their counterparts. Conclusion: Female faculty were less likely to be involved in research than men counterparts. The University needs to narrow the gender gap in research by designing and implementing an appropriate intervention strategy. [Ethiop. J. Health Dev. 2021; 35(SI-2):15-21]Keywords: Addis Ababa University, female faculty, gender difference, publication, researc

Adapting and piloting a social contact-based intervention to reduce mental health stigma among primary care providers:Protocol for a multi-site feasibility study

Stigma among primary care providers (PCPs) is a barrier to successful integration of mental health services in primary healthcare settings globally. Therefore, cross-culturally adaptable and feasible strategies are needed to reduce stigma among PCPs. This protocol is for a multi-site pilot study that aims to adapt and evaluate cross-cultural feasibility and acceptability of a social contact-based primary healthcare intervention in 7 sites in 5 low-and-middle-income countries. A mixed methods pilot study using an uncontrolled before-after study design will be conducted in China (Beijing, Guangzhou), Ethiopia (Sodo), India (Bengaluru, Delhi), Nepal (Syangja), and Tunisia (Testour). The intervention, entitled REducing Stigma among HealthcAre ProvidErs (RESHAPE), is a collaboration with people with lived experience of mental health conditions (PWLE), their family members, and aspirational figures (who are PCPs who have demonstrated high motivation to integrate mental health services). PWLE and their family members are trained in a participatory technique, PhotoVoice, to visually depict and narrate recovery stories. Aspirational figures conduct myth busting exercises and share their experiences treating PWLE. Outcomes among PCPs will include stigma knowledge, explicit and implicit attitudes, and mental healthcare competencies. To understand the feasibility, and acceptability of the intervention, qualitative interviews will be carried out with PWLE, family members, and aspirational figures, PhotoVoice trainers, mental health specialists co-leading the primary care trainings, and PCPs receiving mental health training. The sites will also generate evidence regarding feasibility, acceptability, recruitment, retention, fidelity, safety, and usefulness of the intervention to make further adaptations and modifications. The results will inform cross-cultural guidelines for collaboration with PWLE when conducting mental health training of primary healthcare workers. The results will be used to design future multi-site hybrid trials focusing on effectiveness and implementation

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

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

BACKGROUND: People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions. METHODS: This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions. RESULTS: A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care. CONCLUSION: There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia