The HIV-1 epidemic in Ethiopia – transmission patterns, antiretroviral drug resistance and treatment outcomes

A comprehensive understanding of local HIV epidemiology is essential for monitoring transmission, designing, implementing, and evaluating HIV intervention strategies. In paper I, we used a total of 1276 HIV-1 subtype C pol sequences and employed state-of-art phylogenetic and phylodynamic tools to describe the molecular epidemiology of HIV in Ethiopia. Our results showed that the HIV epidemic in Ethiopia resulted from two independent introductions of the founder virus from Eastern Africa and southern African countries in 1975 and 1983, respectively. Our phylodynamic analysis also revealed that the HIV-1 epidemic in Ethiopia manifested expanding growth from its introduction until mid-1990s, followed by a sharp decline in HIV-1 transmissions. The epidemic decline coincided with early behavioral, preventive, and public health awareness campaigns implemented in Ethiopia, a decade before the introduction of antiretroviral therapy (ART) in the country.Global evidence suggests that the rapid expansion of ART is associated with increase in pretreatment drug resistance (PDR) and acquired drug resistance (ADR), posing threat to both individual outcomes and the prospect of elimination of HIV as a public health threat. We employed WHO-recommended threshold survey method in paper II to assess the transmitted drug resistance (TDR) in Gondar. Our result showed a moderate level of TDR in Gondar, all of which were associated to non-nucleoside reverse transcriptase inhibitor (NNRTI). Our findings also revealed a high rate of HIVDR transmission with the G190A mutation. In paper III, we investigated the emergence of ADR among adults receiving ART in health centers. Our results showed that among 621 individuals, 16.3% had virological failure (VL≥500 copies/mL) at six and/or twelve months, of which 65.3% had ADR. In paper IV, we assessed the prevalence of virological failure, ADR and PDR among female sex workers (FSWs) who participated in the 2014, Ethiopian nationwide biobehavioral survey. PDR was detected in 16.5 % (63/381) FSWs of which 14.4%, 10.5% and 9.2% were associated to NNRTI, nucleoside reverse transcriptase inhibitors (NRTIs), and dual-class, respectively. Among the 239 FSWs on-ART, 59 (24.7%) had virological failure, of which 74.4% had one or more major HIV drug resistance mutations (HIVDRMs). In paper V, we found no dolutegravir-associated HIVDRMs among 460 INSTI-niave (integrase strand transfer inhibitor), participants in the 2017 Ethiopian national HIVDR surveillance, regardless of previous exposure to ART (NNRTIs, NRTIs and/or protease inhibitors). Furthermore, 64.9% of HIV-1 subtype C integrase amino acid positions were conserved (<1.0% variability)

Data and Information Literacy: Achieving Sustainable Development Goals in Africa

Libraries, especially academic and research libraries, are increasingly taking on the task of supporting their community of users in data collection, analysis, management, and preservation - an area of charge that came to be known as research data management (Tenopir, Sandusky, Allard, & Birch, 2014). As Africa enters the post-2015 development agenda, i.e. Sustainable Development Goals, that has 17 goals and 169 targets (United Nations, 2015), the successful accomplishment and outcome of such goals and targets can only be known if appropriate data is collected, analyzed and evidence is presented. In view of these ambitious and daunting challenges, it is imperative to prepare librarians with skills and knowledge needed to manage and preserve research data. This paper aims to shed light on the requisite skills and knowledge needed by librarians to play active role in the SDG agenda. Important concepts, skills, tools, methods, and applications on the topics of data and information literacy will be investigated

MEASUREMENTS OF EDUCATIONAL TECHNOLOGY

The domain of technology in education (or educational technology) is quite broad and it is difficult to pin it down to one area of application, software, device, or tool. The purpose of this study is not on technology as an object of study taught on its own right, but as a tool closely intertwined with pedagogy in an effort to enhance, innovate, and/or transform the teaching learning experience. Moreover, the focus is on technology used in classroom settings across the P-20 domain as opposed to technology used in online or distance education. It is true in today’s interconnected environment, learning often occurs outside of the four walls of the school and to that end we recognize the influence of technology used in classroom setting can extend beyond the school system as students, teachers and other stakeholders interact and manipulate educational resources while at home or in the library, for example. Although the focus of this study is on the use of technology in traditional face-to-face teaching and learning it needs to be underscored that boundaries are increasingly blurred between internal and external environments

Bibliography of the Literatures on Tuberculosis, TB/HIV and MDRTB in Ethiopia from 2001 – 2017

Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tuberculosis (MDR-TB) and Tuberculosis/Human Immunodeficiency Virus (TB/HIV). Given the public health importance of the problem, it is apparent that probing the work done in this regard is essential to mitigate the problem and thus we reviewed research repositories and compile directories of researches in Ethiopia from Jan 1, 2001 to Dec 30, 2017 in order to avail evidence-based information to stakeholders and beneficiaries intervening the problem in the country. The evidences generated in this bibliography are through different databases and websites using key terms. A range of different published and unpublished literatures (journal articles, conference presentations, reports/manual/book, and graduate theses or dissertations) on TB, MDR-TB, extensively drug resistant TB (XDR-TB), or TB/HIV are presented. We presented literatures by four themes (Biomedical and clinical researches, epidemiological researches, operational or implementation researches, and health systems researches). A total of 1571 researches and reports were accessed through the above search engines and revealed 635 epidemiological researches followed by 538 clinical or biomedical researches, 257 operational or implementation research, and 141 health systems research. Interestingly, up to 2008 clinical or biomedical researchers were the leading researches and from 2009 onwards, epidemiological researches held the largest constituency. In conclusion, TB or TB/HIV and MDR-TB literatures in Ethiopia have substantially increased over years. Referred journal publications took theleading source and epidemiologic studies were the commonest one. We suggest the need to focus on operational or implementation and health system researches to plummet the disease spreading, drug resistance and impact. We also recommend a regular update of the bibliography every 3 to 4 years with annotations

Understanding climate and land surface changes impact on water resources using Budyko framework and remote sensing data in Ethiopia

Climate change and land degradation are the two drivers playing a significant role in changing freshwater availability. Targeted intervention requires understanding the role of each driver and their spatial dominance. However, detangling the effects of these factors and identifying where each plays the most important role is still unclear. In this study, we used Budyko-like framework and remote sensing data to evaluate the spatial effects of climate and land surface changes on water availability in Ethiopia. At national level, the mean long-term annual runoff change after 20 years is positive (about 80 mm/year), and is equally accountable to climate change (50%) and landscape surface changes (50%). However, both the change and contribution of the two factors vary spatially. In northern (Tigray region) and southeastern (Somali region) Ethiopia, the contribution of climate change is larger than the land surface changes on water resources. Particularly in the southeastern part of the country (Somali region), 70% of the changes in water resources is attributed to climate change. In most areas of the country, the change in water resources due to land surface change is positive. The detail percentage contribution of the two factors on the water resource change for each administrative zone is provided

Catalogue of sustainable land management and climate smart agriculture practices in Ethiopia

Massive SLM/CSA practices have been implemented for the last four decades in various agro-ecologies of Ethiopia. Nevertheless, these practices were not well catalogued in illustrative (pictorial) representation. Cataloguing Sustainable Land management (SLM) and Climate Smart Agriculture (CSA) practices, technologies and approaches are important in helping us to understand what we have, where they are located and what stories they tell. The first attempt is thus being made to catalogue and document the major SLM and CSA practices, technologies and approaches in Ethiopia with illustration of the practices as much as possible. The catalogue can be considered a live document which is open for revision based on the availability of new and additional information. In addition, the content and style of the catalogue can be improved with input from SLM and CSA experts in the country and beyond. The catalogue is developed by experts drawn from various institutions including The Bioversity International and CIAT (ABC), the Ministry of Agriculture (MoA) and the Ethiopian Institute of Agricultural Research (EIAR). Information was obtained from individual researchers who have amassed huge experience over long period of time. Photo galleries were acquired from different projects such as SLMP, RLLP/CSA and PSNP through project leaders and focal persons in various regions. Once the draft was prepared by these experts, the catalogue was verified and validated by experts from regions including Amhara, Benishangul Gumuz, Gambella, Oromia, Sidama, SNNP and Southwestern Ethiopia. The validation was done during the CSA training whorkshop which was held in November 20 to 25, 2022 at Adama, Ethiopia. The catalogue provides a short description of practices including issue to be addressed, scale of implementation, agro-ecological zones, suitable land use and limitations. Most of the illustrations used were collated from successful cases to create awareness, facilitate adoption and support the notion ‘seeing believing’. Generally, the catalogue contained about 70 practices under four categories; physical, biological, agronomic, water management and mixed (other) practices. The catalogue can serve stakeholders including researchers, development agencies and academia test, validate, implement and adopt in their localities

Prevalence and Associated Factors of Violence against Hospital Staff at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia.

Background. Violence at the workplace has become an alarming phenomenon worldwide. The real size of the problem is largely unknown and recent information shows that the current knowledge is only the tip of the iceberg. The enormous cost of violence at the workplace for person and community at large is becoming more apparent. It could be physical, sexual, and verbal in nature and could be actual or threatened. Objectives. To access prevalence and associated factors of violence against hospital staff at Amanuel Mental Specialized Hospital Addis Ababa, Ethiopia. Methods. An institution based cross-sectional study was employed in 2017. The data were collected using Workplace Violence in the Health Sector Country Case Study Questionnaire from 496 participants. Participants had been selected using simple random sampling technique and data were collected using a self-administered structured questionnaire. The collected data were entered into Epi-data version 3.1, and SPSS version 21 was used for Analysis. Binary logistic regression was fitted to identify factors associated with the outcome variable. Result. From 496 staff intended to have participated in this study, complete data were obtained from 435, making a response rate of 87.7%. This research showed high prevalence of violence and we have got that staff had been exposed to physical violence 36.8%, verbal violence 62.1%, and sexual violence 21.8 % over the past year, respectively. Age, sex, and contact with the patient were statistically significant variables (p < 0.05). Conclusion and Recommendation. According to this study, majority of AMSH staff were violated by the patient they care.Peer Reviewe

Preparedness of the Urban Health Extension Program to provide priority health services identified in its packages

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at a household level – is one of the three approaches of the national Health Extension Program (HEP).The UHEP is organized to deliver services within 16 packages. This study is aimed at assessing the preparedness of the program to provide priority health services identified in its packages. Methodology: The study covered sampled urban health extension facilities within five study regions, and included 26 facility assessments, and 330 urban health extension professionals’ (UHE-ps’) assessments. Results: According to the findings of the facility assessment, most items within the UHEP packages are available, even though very few facilities were found to stock delivery kits, dressing materials, and oxytocin. Adrenaline was also observed to be found in only a limited number of facilities. Regarding teaching aids and services guidelines, most of the facilities had health education materials, Health Management Information System (HMIS) recording and reporting formats, family health services guidelines, disease prevention guidelines, family planning guidelines, and environmental health guidelines. All of the facilities observed seemed to have most of the services that are prioritized within the UHEP packages. The items less available include HIV testing and counseling guidelines, first aid kits, and infant weighing scales. A knowledge assessment through a test of 327 UHE-ps using questions based on the guideline manual showed a mean score of 76.2% (32 out of 42), with a minimum of 33.3% (10 out of 42) and maximum of 90.5% (38 out of 42). Considering the mean score (76.2%) as the passing grade, only 43% of the UHE-ps scored above the average. Questions on controlling communicable diseases and postnatal care (PNC) were items on which the UHE-ps scored highest. Conclusions and Recommendations: The findings of the present survey show that there is an overall fair level of preparedness within the UHEP to provide the services identified within its various component packages. However, there are still a few services packages for which the UHE facilities do not seem to be well prepared. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):76-82] Keywords: Preparedness; Urban Health Extension Program; Urban Health Extension Professionals

Degree of adherence of the urban health extension service delivery process to the standards set nationally

Background: The Urban Health Extension Program (UHEP) is an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at the household level. Even though the HEP was launched in Ethiopia in 2003 as the flagship program for the implementation of primary health care in the country, studies looking at its quality are limited. Adherence to set standards within a program is one of the parameters that indicate process quality. This paper, part of a larger survey to assess the quality of services provided by the UHEP in Ethiopia, looks at the degree of adherence to the service delivery process to the standards set nationally. Methodology: The study included an assessment of the degree of adherence of the urban health services delivery process to the national standards in selected urban health extension facilities within the catchment areas of sampled institutions. The assessment was made using observation checklists of the routine service provision of the health professionals. Data collection for the survey included the assessment of the service delivery practices of 330urban health extension professionals (UHE-ps) in five major regions. Results: When compared with the standards set in the national program implementation manual, environmental sanitation and counseling of mothers (99.4%), essential nutrition action (in terms of growth monitoring and provision of vitamin A and iron supplementation) (95.4%), HIV/AIDS and STI-related services (95.1%), antenatal care (87.6%), adolescent reproductive health(RH) services (82.1%), family planning services (81%) and facilitating immunization (63.7%) were reported to have good performance. On the other hand, childhood curative services (22%), curative care for pregnant mothers (24.2%), delivery care (25.4%), and follow-up of treatment for leprosy cases (25.5%) were reported to have comparatively low performance. Conclusions: Overall, the comparison of adherence to standards set by the UHE-ps implementation manual showed that the most preventive and health promotive services (including HIV/AIDS and STI) were regularly provided, while the low performance of UHEps was reported in delivery-related and curative services (including those given to pregnant women and children. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):62-69] Keywords: Adherence to standards; Urban Health Extension Program; Urban Health Extension Professionals