Patterns of knowledge and condom use among population groups: results from the 2005 Ethiopian behavioral surveillance surveys on HIV

<p>Abstract</p> <p>Background</p> <p>Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among sub populations selected for behavioral surveillance in Ethiopia.</p> <p>Methods</p> <p>We used 2005 HIV/AIDS behavioral data from ten target groups. These were female sex workers, defense forces, police force, pastoralists, truck drivers, intercity bus drivers, road construction workers, teachers, factory workers and people in ANC catchment areas.</p> <p>Results</p> <p>Data from 14,524 individuals were analyzed. The majority were males (63.6%). Overall, knowledge of the three preventive methods, misconceptions and comprehensive knowledge was 57%, 75% and 18.5%, respectively. Female sex workers and the defense force showed some behavioral change in using a condom during the most recent sexual encounter and consistently used a condom with non-regular sexual partners and paying partners. Women, pastoralists and the illiterate were less likely to use condom.</p> <p>Conclusion</p> <p>Misconceptions about the transmission of HIV were high and comprehensive knowledge about HIV & AIDS was low, particularly among pastoralists. Consistent condom use and condom use during the last sexual encounter were high among both female sex workers and defense force employees, both with paying and non-regular sexual partners. This might be a positive sign, though a considerable proportion in each target group did not report using a condom during sex with non-regular partners.</p

Thyroid Hormone Tests Ordering Practice and Cost-Effectiveness in Samples Referred to International Clinical Laboratories from Addis Ababa Health Facilities

BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves’ disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients’ samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL.RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal.CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common

Outcomes of antiretroviral treatment program in Ethiopia: Retention of patients in care is a major challenge and varies across health facilities

BACKGROUND: Many resource-limited countries are scaling up antiretroviral treatment (ART) towards universal access. However, there are few studies which evaluated outcomes of ART programs in these countries. In addition, these studies generally include a limited number of facilities and patients creating a clear need for studies with a wide range of facilities and large numbers of patients. In this study, we intended to evaluate the outcomes of the ART services in 55 health facilities in Ethiopia. METHODS: A retrospective longitudinal study was conducted to determine levels of patient retention in care, CD4 count and shift to second-line ART regimen in 30 hospitals and 25 health centers selected as sentinel sites for monitoring the outcomes of ART program in the country. The outcomes were determined at baseline, after 6, 12 and 24 months on ART. Data was collected from routine patient registers and charts, and entered and analyzed using EPI-Info statistical software. RESULTS: Health facilities were able to retain 29,893 (80%), 20,079 (74%) and 5,069 (68%) of their patients after 6, 12 and 24 months on ART, respectively. Retention rates vary across health facilities, ranging from 51% to 85% after 24 months on ART. Mortality was 5%, 6% and 8% after 6, 12 and 24 months on ART. More than 79% of patients with available CD4-cell counts had a baseline CD4-cell counts less than 200 cells per micro-liter of blood. The median CD4-cell counts (based on patients who were retained after 24 months on ART) increased from 125 (inter-quartile (IQ), 68-189) at baseline to 242 (IQ, 161-343), 269 (IQ, 185-380) and 316 (IQ, 226-445) cells per micro-liter after 6, 12, and 24 months on ART, respectively. The transition to second-line ART remained very low, 0.33%, 0.58% and 2.13% after 6, 12 and 24 months on ART. Discussion and conclusion: The outcomes of the ART services in the 55 health facilities in Ethiopia are similar to those in other countries. Retention of patients in care is a major challenge and varies across health facilities with high, medium and low retention rates. We therefore recommend further studies to understand the organization of care in health facilities with high, medium and low retention rates. It is also imperative that early initiation of patients on ART is taken seriously as more than 79% of the patients had baseline CD4-cell counts less than 200 cells per micro-liter of blood. Finally, we recommend that the shift to second-line ART might be too low and warrants close monitoring

Is the adapted Household Food Insecurity Access Scale (HFIAS) developed internationally to measure food insecurity valid in urban and rural households of Ethiopia?

Background The concept of food insecurity encompasses three dimensions. One of these dimensions, the access component of household food insecurity is measured through the use of the Household Food Insecurity Access Scale (HFIAS). Despite its application in Ethiopia and other similar developing countries, its performance is still poorly explored. Our study aims to evaluate the validity of the HFIAS in Ethiopia. Methods We conducted repeated cross-sectional studies in urban and rural villages of the Butajera District in southern Ethiopia. The validation was conducted on a pooled sample of 1,516 households, which were selected using a simple random sampling method. The HFIAS was translated into the local Amharic language and tested for face validity. We also evaluated the tool’s internal consistency using Cronbach’s alpha and factor analysis. We tested for parallelism on HFIAS item response curves across wealth status and further evaluated the presence of a dose-response relationship between the food insecurity level and the consumption of food items, as well as between household wealth status and food insecurity. Additionally, we evaluated the reproducibility of the tool through the first and second round of HFIAS scores. Results The HFIAS exhibited a good internal consistency (Cronbach’s alpha for the values of rounds 1 and 2 were 0.76 and 0.73, respectively). A factor analysis (varimax rotation) resulted in two main factors: the first factor described a level of mild to moderate food insecurity, while the second factor described severe food insecurity. HFIAS item response curves were parallel across wealth status in the sample households, with a dose-response trend between food insecurity levels and the likelihood of previous day food consumption being observed. The overall HFIAS score did not change over the two rounds of data collection. Conclusions The HFIAS is a simple and valid tool to measure the access component of household food insecurity. However, we recommend the adaptation of questions and wordings and adding examples before application, as we found a discrepancy in understanding of some of the nine HFIAS questions

Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia

BACKGROUND Endemic non-filarial elephantiasis or podoconiosis is a chronic and debilitating geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a major public health problem in countries in tropical Africa, Central America and North India. OBJECTIVE To estimate the direct and the average productivity cost attributable to podoconiosis, and to compare the average productivity time of podoconiosis patients with non-patients. METHODS Matched comparative cross sectional survey involving 702 study subjects (patients and non-patients) supplemented by interviews with key informants in Wolaita Zone, southern Ethiopia. RESULTS Total direct costs of podoconiosis amounted to the equivalent of US$143 per patient per year. The total productivity loss for a patient amounted to 45$ 63. In Wolaita zone, the overall cost of podoconiosis exceeds US$ 16 million per year. CONCLUSIONS Podoconiosis has enormous economic impact in affected areas. Simple preventive measures (such as use of robust footwear) must be promoted by health policy makers

Climate change, crop production and child under nutrition in Ethiopia; a longitudinal panel study

Background: The amount and distribution of rainfall and temperature influences household food availability, thus increasing the risk of child under nutrition. However, few studies examined the local spatial variability and the impact of temperature and rainfall on child under nutrition at a smaller scale (resolution). We conducted this study to evaluate the effect of weather variables on child under nutrition and the variations in effects across the three agro ecologies of Ethiopia. Methods: A longitudinal panel study was conducted. We used crop productions (cereals and oilseeds), livestock, monthly rainfall and temperature, and child under nutrition data for the period of 1996, 1998, 2000 and 2004. We applied panel regression fixed effects model. Results: The study included 43 clusters (administrative zones) and 145 observations. We observed a spatio temporal variability of rainfall, stunting and underweight. We estimated that for a given zone, one standard deviation increase in rainfall leads to 0.242 standard deviations increase in moderate stunting. Additionally, a one standard deviation increase temperature leads to 0.216 standard deviations decrease in moderate stunting. However, wasting was found to be poorly related with rainfall and temperature. But severe wasting showed a positive relationship with the quadratic term of rainfall. Conclusions: We conclude that rainfall and temperature are partly predicting the variation in child stunting and underweight. Models vary in predicting stunting and underweight across the three agro ecologic zones. This could indicate that a single model for the three agro ecologies may not be not applicable