13 research outputs found
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Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016
The last 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs may reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems
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Understanding the caring network of podoconiosis patients in Rwanda: a qualitative study
Introduction: Globally, a total of almost 4 million people live with podoconiosis in 32 potentially endemic countries including Rwanda. Podoconiosis is a non-infectious geochemical disease that causes massive swelling of the lower leg and is caused by long-term exposure to red clay soil found in tropical highland areas. The disease is a disabling neglected tropical disease (NTD) and is associated with profound stigma, discrimination and comorbid mental health conditions. Treatment interventions are commonly known as morbidity management and disability prevention. Both biomedical and traditional treatments are used by affected people. However, understandings informed by the social sciences of care in the context of NTDs are largely unexplored. This study explored the perspectives and experiences of care among care receivers (podoconiosis patients) and caregivers (family members, traditional healers) in the district of Huye, Rwanda. Method: The study used qualitative methods including seventeen InDepth Interviews (eleven patients, two traditional healers, two care professionals, and two family members) and participant observation in a health centre and patients’ houses. Result: A caring network was found amongst the podoconiosis patients, their family members, care professionals and traditional healers. Caring network is not only about the medical treatments, but also about the caring relationship amongst them. Discussion: Using notions of ‘Network’ and ‘Collectives’, from the care ethics literature the study shows that in addition to care work requiring professional know-how, it is also about the relationships between patients, their families, traditional healers, and biomedical care professionals.</p
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The effect of contextual factors on a health intervention against podoconiosis in Ethiopia
IntroductionUnderstanding contextual factors that influence the implementation and outcome of interventions is crucial to improving them. Outcome and process evaluation studies have to date focused on the successes and limitations of interventions with little consideration of external factors that could either facilitate or impede them. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated the effect of contextual factors on a health intervention implemented against the neglected tropical disease (NTD) podoconiosis in Ethiopia.MethodWe purposefully selected a health intervention jointly implemented by two NGOs in podoconiosis-endemic districts in Northwestern Ethiopia. We employed an exploratory mixed methods approach, and data were collected between April and July 2022. We first conducted document analysis, observations, 4 focus group discussions, 32 in-depth interviews and 19 key informant interviews. Subsequently, we administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. The qualitative data were managed with NVivo version 12 software. The quantitative data were analyzed using Stata version 15 software.ResultsMost project activities were implemented as per the initial plan and the intervention reached patients that never had access to treatment services before. Contextual factors (geographical, epidemiological, socio-economic, socio-cultural, ethical, legal and political) and lived experience of patients influenced the implementation and outcome of the intervention. Most of the contextual factors pose constraints on implementation and affected the acceptability and sustainability of project activities. On the other hand, political context such the commitment of the government to rollout national programs and set up NTD structures at district level positively influenced the implementation of the intervention.ConclusionHealth intervention implementors should be aware of the interactive effects of contextual factors wherein interventions are put into practice. Minimizing the constraining effects of these contextual factors while utilizing opportunities presented by them might help implement optimal strategies to improve the lives of individuals affected by podoconiosis and similar NTDs.</p
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Evaluating rural Ethiopian youths’ willingness and competency to be literacy builders for G x E influences on podoconiosis
Introduction: Engaging youth as peer educators has yet to be considered in the context of promoting literacy concerning conjoint genetic and environmental (GxE) influences on health conditions. Whether youth living in Low and Middle Income Countries (LMICs) could and would be willing to serve as lay educators of GxE education is unclear. Methods: A cross-sectional survey of youth living in Southern Ethiopia was conducted from August to September 2017. Trained data collectors administered the survey on 377 randomly selected youth who ranged in age from 15-24; 52% were female and 95% reported having some formal education. Self-reported willingness and a constructed competency score were assessed. Bivariate analyses tested for factors associated with willingness and competency to serve as lay GxE literacy builders. Results: Competency and willingness were significantly greater (p<0.05) for youth who: were male, had some formal education, and had civic or leadership experience. Differences in median willingness were significant for youth who scored as more competent versus those who scored as less competent (p<0.001). There were no characteristics that moderated the association of competency with willingness. Conclusion: Youth peer educator programs could hold promise for disseminating improved GxE literacy among LMICs. Thoughtful recruitment and training strategies will be needed to ensure that the broadest representation of yout
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No secondary impact of ivermectin mass drug administration for onchocerciasis elimination on the prevalence of scabies in northern-western Ethiopia
Introduction
Mass Drug Administration (MDA) is among the five major strategies that are currently in use to control, eliminate, or eradicate Neglected Tropical Diseases (NTDs). Optimizing Mass Drug Administration (MDA) to control multiple NTDs maximizes impact. The objective of this study is to estimate the secondary impact of ivermectin MDA for onchocerciasis on the prevalence of scabies.
Methods
This quasi-experimental study was conducted in Ayu Guagusa district, northern-western Ethiopia. Scabies prevalence was estimated in surveys before the MDA, at 6 and 12-months afterwards. The sample size was 1437 people from a panel of 381 randomly selected study households. Multistage sampling was employed in randomly selecting six kebeles (the lowest administrative unit) with respective gotes (small villages) and households. All members of the selected households were invited to participate in the study and participants who were available in all three surveys formed a cohort. Health care workers from a nearby hospital diagnosed scabies cases.
Results
Scabies prevalence was similar prior to the MDA (13.4%, 95% CI: 11.7%-15.2%) and 6 months after (11.7%, 95% CI: 10.1%-13.2%) but was substantially greater at 12 months (22.1%, 95% CI: 20.1%-24.1%). The six-month incidence and disappearance rates were 10.8% (95% CI: 8.8%-13.2%) and 82.6% (95% CI: 75.0%-88.6%), respectively.
Conclusion
Ivermectin MDA for onchocerciasis did not have a significant secondary impact on the prevalence of scabies over 12 months follow-up period
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The role of a community conversation intervention in reducing stigma related to lower limb lymphoedema in Northern Ethiopia
Background: Stigma related to lower-limb lymphoedema poses a major psychosocial burden to affected persons and acts as a barrier to them accessing morbidity management and disability prevention (MMDP) services. Community Conversation (CC), which actively engages community members and disseminates health information amongst them, is believed to break the vicious cycle of stigma by enhancing disease-related health literacy at the community level.
Methods: A quasi-experimental study was conducted in Northern Ethiopia to assess the role of the CC intervention in reducing stigma. In two control districts, a comprehensive and holistic MMDP care package was implemented that included physical health, mental health and psychosocial interventions, whilst in the intervention district the CC intervention was added to the MMDP care package. A total of 289 persons affected by lymphoedema and 1659 community members without lymphoedema were included in the study.
Results: Over the course of the intervention, in all sites, community members’ knowledge about the causes of lymphoedema increased, and perceived social distance and stigmatizing attitudes towards people with lymphoedema decreased in the community, whilst experienced and internalized stigma decreased amongst affected persons. There were no significant changes for perceived social support. However, the changes were greater in the control sites overall, i.e. those districts in which the holistic care package was implemented without CC.
Conclusion: The findings suggest that the CC intervention provides no additional stigma reduction when used alongside a holistic MMDP care package. Provision of comprehensive and holistic MMDP services may be adequate and appropriate to tackle stigma related to lower-limb lymphoedema in a resource-constrained setting like Ethiopia.</p
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Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge
Background The WHO aims to prevent, eliminate or control neglected tropical diseases, including scabies, by 2030. However, limited epidemiological data presented a challenge to control efforts, especially in high burden countries. There was a major scabies outbreak in northern Ethiopia starting in 2015 and prevalence has since increased across much of the country.Objective To estimate scabies prevalence, identify its predictors, and assess community perception of, and knowledge about, the infestation.Design Population-based cross-sectional study.Study setting Ayu Guagusa district, Amhara region, northern Ethiopia.Participants 1437 people who were members of 381 randomly selected households participated in the study. Five trained mid-level health workers clinically diagnosed people with scabies.Outcome measures Clinically diagnosed scabies infestation.Data analysis Multi-level logistic regression models were fitted to adjust for individual and household-level confounding variables, and identify predictors of scabies infestation.Results Scabies prevalence was 13.4% (95% CI 11.8 to 15.5). Households of more than five people (adjusted OR (aOR)=3.5, 95% CI 1.2 to 10.2) were associated with increased odds of developing scabies, however, females had lower odds (aOR=0.5 95% CI 0.3 to 0.8). Scabietic lesions most frequently involved the trunk (62.0%), and vesicles were the most common types of lesions (67.7%). Two-thirds of adult study participants had heard about scabies and most obtained scabies related information from informal sources. Only 32% of cases sought care for scabies from any source.Conclusion Scabies prevalence was high, signifying the need for community-based control interventions. Host density and sex were important predictors of scabies. Despite the favourable attitude toward the effectiveness of scabies treatment, healthcare seeking was low.</p
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Digital health inclusion: a pilot study of health services deployment using communications satellite for the underserved in Nigeria
Health service delivery in Nigeria is constrained by: brain drain, insufficient infrastructure and technology, poor and inadequate medical facilities and paucity of medical specialists in rural and remote regions - thus leading to a high rate of “medical tourism”. With increasing mobile phone ownership in Nigeria, mobile technology-based telemedicine has the potential to improve Nigeria’s healthcare delivery with enabling infrastructural facilities. In this paper, a pilot study that uses Nigeria’s communication satellite system for virtual Telemedicine connection between health practitioners and underserved communities using the “one2one” mobile telemedicine application is reported. This pilot study aimed to deploy Nigeria’s communication satellite system to enable virtual telemedicine connection between health practitioners and underserved communities using the “one2one” mobile telemedicine app. Successful deployment of a 1.8m VSAT dish at the pilot clinic and testing showed robust internet connectivity with a time delay of 250ms per hop. Furthermore, the One2one app was successfully installed on health practitioners’ tablets/phone and patients’ phone/tablets. Over 100 patients were treated using the one2one app connected through the satellite internet. The one2one app was highly rated by patients and healthcare providers in terms of usability with the highest score being ease of use 87%. This study shows that Nigeria’s communications satellite can be deployed to support mobile telemedicine as part of the effort to increase access to doctors and specialists in medically underserved areas of Nigeria
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Evidence for immune activation in pathogenesis of the HLA class II associated disease, podoconiosis
Available evidences suggest that podoconiosis is triggered by long term exposure of bare feet to volcanic red clay soil particles. Previous genome-wide studies in Ethiopia showed association between the HLA class II region and disease susceptibility. However, functional relationships between the soil trigger, immunogenetic risk factors and the immunological basis of the disease are uncharted. Therefore, we aimed to characterise the immune profile and gene expression of podoconiosis patients relative to endemic healthy controls. Peripheral blood immunophenotyping of T cells indicated podoconiosis patients had significantly higher CD4 and CD8 T cell surface HLA-DR expression compared to healthy controls while CD62L expression was significantly lower. The levels of the activation markers CD40 and CD86 were significantly higher on monocytes and dendritic cell subsets in patients compared to the controls. RNA sequencing gene expression data indicated higher transcript levels for activation, scavenger receptors, and apoptosis markers while levels were lower for histones, T cell receptors, variable, and constant immunoglobulin chain in podoconiosis patients compared to healthy controls. Our finding provides evidence that podoconiosis is associated with high levels of immune activation and inflammation with over-expression of genes within the pro-inflammatory axis. This offers further support to a working hypothesis of podoconiosis as soil particle-driven, HLA-associated disease of immunopathogenic aetiology.</p
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Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review
Background: More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization’s current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country’s NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. Methods: A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. Results: The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. Conclusions: The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.</p