An assessment of the health care system for diabetes in Addis Ababa, Ethiopia

Background: During the past decade, diabetes mellitus has emerged as an important clinical and public health problem through out the world. WHO estimated the number of cases of diabetics in Ethiopia to be about 800,000 in 2000, and projected that it would increase to about 1.8 million by the year 2030. Care for diabetic patients may require close and sustained support from a health care team, adequate financial resources, and advanced patient knowledge and motivation. In this respect, there is lack of information in the country.Objective: This study was conducted with the aim of assessing the characteristics of the health care system for diabetic patients, how diabetic patients are cared for including medical care and adequacy of facilities for the prevention of complications and outcomes at primary health care and secondary health care levels. Methods: An assessment of the characteristics of the health care system (structure) for diabetic patients was conducted in 21 health centres (primary health care level) and 5 regional hospitals (secondary health care level) in Addis Ababa. Furthermore, a total of 106 diabetic patients drawn from six out of the 21 health centres and another 123 diabetic patients drawn from three of the six hospitals were consecutively interviewed.Results: All the Regional hospitals and one of the health centres were running established diabetic referral clinics. Similarly, a lack of professionals was observed in all the health institutions in general and the health centres, in particular. Only 21% of patients had access for blood glucose monitoring at the same health institutions. The emphasis given for diabetic education (24%) was less than expected. Only 11 (5%) of diabetic patients were able to do self blood glucose monitoring at home. Fifty one percents of patients didn't have urine analysis, BUN, creatinine and lipid profile in the previous 1-2 years. None of diabetic patients had haemoglobin Alc (HbA1c) determination. Nearly 75% of the patients required admissions directly or indirectly due to uncontrolled diabetes. About 87% of the diabetics had regular follow ups at their respective health centres and hospitals. Hypertension (34%), diabetes related eye disease (33%) and renal disease (21%) were the major associated illnesses observed among the diabetics. Sixty-six patients (23%) had a total of about 131 admissions.Conclusion: Although there is a well-established health infrastructure for diabetics care in Addis Ababa, the diabetic care is below the acceptable standard. The finding of this study may, thus, help to clarify issues related to potential changes in the health care system dealing with diabetes and for strengthening the referral system for diabetes health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 203-21

HIV-infected adolescents have low adherence to antiretroviral therapy: a cross-sectional study in Addis Ababa, Ethiopia

Introduction: For antiretroviral therapy (ART) to work effectively, adherence is very crucial. However, most studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents.Methods: Using a cross-sectional study design, we interviewed 273 HIV-infected adolescents receiving ART from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports. Bivariate and multivariate methods were used for analysis.Results: We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%) of the participants were girls. Their mean age was 15.4 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). On bivariate analysis, variables like WHO clinical stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART or not and having special instructions for ART medications were associated with optimum adherence. However of those, only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 95% CI, 0.124-0.97) and adolescents with widowed parent (adjusted OR, 0.087 with 95% CI, 0.021-0.359) were found to be significantly associated with optimum ART adherence.Conclusion: The level of self-reported ART adherence among HIV-infected adolescents at the three hospitals was below the recommended threshold. Though earlier presentation of adolescents to care should be encouraged, more targeted adherence support should be planned for those who present at an early stage of their illness.Keywords: Antiretroviral therapy, adherence, adolescent, patient self-report, Addis Ababa, Ethiopi

Prevalence and factors affecting use of long acting and permanent contraceptive methods in Jinka town, Southern Ethiopia: a cross sectional study

Introduction: In Ethiopia, knowledge of contraceptive methods is high though there is low contraceptive prevalence rate. This study was aimed to assess prevalence and associated factors of long acting and permanent contraceptive methods in Jinka town, southern Ethiopia. Methods: Community based cross sectional survey was conducted to assess the prevalence and factors affecting long acting and permanent methods of contraceptives utilization from March to April 2008. Eight hundred child bearing age women were participated in the quantitative study and 32 purposively selected focus group discussants were participated in the qualitative study. Face to face interview was used for data collection. Data were analyzed by SPSS version 13.0 statistical software. Descriptive statistics and logistic regression were computed to analyze the data. Results: The prevalence of long acting and permanent contraceptive method was 7.3%. Three fourth  (76.1%) of the women have ever heard about implants and implant 28 (50%) were the most widely used method. Almost two third of women had intention to use long acting and permanent methods. Knowledge of contraceptive and age of women have significant association with the use of long acting and permanent contraceptive methods.Conclusion: The overall prevalence of long acting and permanent contraceptive method was low.  Knowledge of contraceptive and age of women have significant association with use of long acting and permanent contraceptive. Extensive health information should be provided.Key words: Long acting, permanent, contraceptive, women, Ethiopi

Prevalence and Correlates of Prenatal Vitamin A Deficiency in Rural Sidama, Southern Ethiopia

A cross-sectional study was conducted to assess the prevalence and correlates of prenatal vitamin A deficiency (VAD) in rural Sidama, Southern Ethiopia. Seven hundred randomly-selected pregnant women took part in the study. Serum retinol concentration was determined using high-performance liquid chromatography. Data were analyzed by logistic and linear regression. Interpretation of data was made using adjusted odds ratio (AOR) and adjusted linear regression coefficient. The prevalence of VAD (serum retinol <0.7 \u3bcmol/L) was 37.9%. Advanced gestational age and elevated C-reactive protein (CRP 655 mg/dL) were negatively associated with retinol concentration (p<0.05). The odds of VAD was significantly higher among the women with no education and those devoid of self-income. Women aged 35-49 years had 2.23 (95% CI 1.31-3.81) times higher odds compared to those aged 15-24 years. The lower the dietary diversity score in the preceding day of the survey, the higher were the odds of VAD. With reference to nulliparas, grand multiparas had 1.92 (95% CI 1.02-3.64) times increased odds of VAD. VAD and zinc deficiency (serum zinc <8.6 \ub5mol/L during the first trimester, or <7.6 \u3bcmol/L during the second or third trimester) were significantly associated with AOR of 1.80 (95% CI 1.28-2.53). VAD has major public-health significance in the area. Accordingly, it should be combated through enhancement of diet diversity, birth control, and socioeconomic empowerment of women

The global atlas of podoconiosis.

The world stands on the edge of an historic public health success with the imminent eradication of dracunculiasis (guinea-worm disease) and polio. Since the World Health Assembly called for the eradication of dracunculiasis in 1986 and poliomyelitis in 1988, astonishing progress has been made. In 2016, only 25 human cases of dracunculiasis were reported from three countries, transmission of wild poliovirus was found in only three countries, and 37 cases of polio were reported worldwide. In addition to these achievements, there has been progress in the elimination of the little-known disease podoconiosis (endemic non-filarial elephantiasis)

Age- and sex-specific HIV-1 prevalence in the urban community setting of Addis Ababa, Ethiopia

Objective: To estimate the age and sex-specific prevalence of HIV infection in th

High levels of methicillin-resistant staphylococcus aureus carriage among healthcare workers at a teaching hospital in Addis Ababa Ethiopia: First evidence using mecA detection

Background: Staphylococcus aureus is a major human pathogen and causes healthcare and community-acquired infection. Data on the extent of MRSA colonization among health-care workers (HCWs) in sub-Saharan Africa are limited. Hence, we determined the burden of MRSA colonisation among HCWs and administrative staff in Tikur Anbessa Specialised Hospital (TASH), College of Health Sciences (CHS), Addis Ababa University, Ethiopia. Methods: Using a cross-sectional study design, participants were screened for MRSA colonisation between June 2018 and August 2019 using nasal swabs. The swabs were analysed using standard laboratory methods including antibiotic resistance gene, mecA. Anonymised sociodemographic data were collected by pretested questionnaires to evaluate HCWs factors associated with MRSA carriage. Results: A total of 588 HCWs and 468 administrative staff were screened for MRSA. Women were over-represented. Overall, 49.1% (289/588) of HCWs were nurses and 25% (117/468) of the administrative staff were cleaners or laundry workers. Overall, 138 S. aureus isolates were retrieved from the nasal swabs of both groups (16.3%, 96/588 from HCWs). The burden of MRSA colonisation was 4.8% (28/580, 95% CI: 3.1–6.5%) among HCWs compared to 0.2%(1/468, 95% CI: 0.18–0.6%) of administrative staff (p value <0.05). The majority of S. aureus and all MRSA isolates were resistant to penicillin. Isolates from HCWs were more resistant to tested antibiotics than administrative staff (P-value <0.05). Conclusion: This is the first report in Ethiopia on MRSA colonization using mecA and revealed that; (i) overall carriage rates of MRSA in HCWs are comparable with observations reported in some other countries and (ii) HCWs exhibit a higher burden of MRSA carriage than administrative staff. Our data support strategic screening of MRSA and antimicrobial stewardship for better intervention measures

Predicted distribution and burden of podoconiosis in Cameroon

Introduction: Understanding the number of cases of podoconiosis, its geographical distribution and the population at risk are crucial to estimating the burden of this disease in endemic countries. We assessed each of these using nationwide data on podoconiosis prevalence in Cameroon. Methods: We analysed data arising from two cross-sectional surveys in Cameroon. The dataset was combined with a suite of environmental and climate data and analysed within a robust statistical framework, which included machine learning-based approaches and geostatistical modelling. The environmental limits, spatial variation of predicted prevalence, population at risk and number of cases of podoconiosis were each estimated. Results: A total of 214,729 records of individuals screened for podoconiosis were gathered from 748 communities in all 10 regions of Cameroon. Of these screened individuals, 882 (0.41%; 95%CI 0.38-0.44) were living with podoconiosis. High environmental suitability for podoconiosis was predicted in three regions of Cameroon (Adamawa, North West and North). The national population living in areas environmentally suitable for podoconiosis was estimated at 5.2 (95% Confidence Interval [CI]: 4.7-5.8) million, which corresponds to 22.3% of Cameroon’s population in 2015. Countrywide, in 2015, the number of adults estimated to be suffering from podoconiosis was 41,556 (95% CI, 1,170- 240,993). Four regions (Central, Littoral, North and North West) contributed 61.2% of the cases. Conclusion: In Cameroon, podoconiosis is more widely distributed geographically than was initially expected. The number of cases and the population at risk are considerable. Expanding morbidity management and follow up of cases is of utmost necessity. Promotion of footwear use and regular foot hygiene should be at the forefront of any intervention plan

Integrated mapping of lymphatic filariasis and podoconiosis: lessons learnt from Ethiopia

BACKGROUND The World Health Organization (WHO), international donors and partners have emphasized the importance of integrated control of neglected tropical diseases (NTDs). Integrated mapping of NTDs is a first step for integrated planning of programmes, proper resource allocation and monitoring progress of control. Integrated mapping has several advantages over disease specific mapping by reducing costs and enabling co-endemic areas to be more precisely identified. We designed and conducted integrated mapping of lymphatic filariasis (LF) and podoconiosis in Ethiopia; here we present the methods, challenges and lessons learnt. METHODS Integrated mapping of 1315 communities across Ethiopia was accomplished within three months. Within these communities, 129,959 individuals provided blood samples that were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). Wb123 antibody tests were used to further establish exposure to LF in areas where at least one ICT positive individual was detected. A clinical algorithm was used to reliably diagnose podoconiosis by excluding other potential causes of lymphoedema of the lower limb. RESULTS A total of 8110 individuals with leg swelling were interviewed and underwent physical examination. Smartphones linked to a central database were used to collect data, which facilitated real-time data entry and reduced costs compared to traditional paper-based data collection approach; their inbuilt Geographic Positioning System (GPS) function enabled simultaneous capture of geographical coordinates. The integrated approach led to efficient use of resources and rapid mapping of an enormous geographical area and was well received by survey staff and collaborators. Mobile based technology can be used for such large scale studies in resource constrained settings such as Ethiopia, with minimal challenges. CONCLUSIONS This was the first integrated mapping of podoconiosis and LF globally. Integrated mapping of podoconiosis and LF is feasible and, if properly planned, can be quickly achieved at nationwide scale

Epidemiology and individual, household and geographical risk factors of podoconiosis in ethiopia: results from the first nationwide mapping

Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1-6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9-4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude