Trend of visceral leishmaniasis at Medicine Sans Frontier´s Abdurafi Treatment Center, West Armachiho District, Ethiopia, 2009-2015, a retrospective descriptive analysis

Introduction: Leishmaniasis currently threatens 350 million men, women and children around the world. Visceral leishmaniasis (VL) is a fatal parasitic disease mostly prevalent in low land areas VL typically affects migrant agricultural workers. Visceral leishmaniasis is caused by the Leishmaniasis donovani complex, which includes Leishmaniasis donovani and Leishmaniasis infantum. An estimated 200,000 to 400,000 new cases of visceral leishmaniasis occur worldwide each year. This study aims to understand the trend, magnitude and mortality of visceral leishmaniasis at MSF Abdurafi treatment center during the period (2009-2015). Methods: Retrospective secondary data analysis was conducted on monthly kala-azar report of MSF Abderafi treatment center in West Armachiho district. We included a total of 11680 patients screened for leishmaniasis in 2009-2015. We entered and analyzed data using Microsoft Excel. Results: Among 11680 patients screened for kalazar in the study period (2009-2015), 2131 were primary kalazar cases, 198 kalazar were relapse and 19 were post kalazar dermal leishmaniasis. The case fatality of kalazar ranged from 0.9% (4/469) in 2014 to 7.4% (22/296) in 2013. The highest cure rate was (96%) in 2015, and the least was (89%) in 2009. The total case fatality rate during study period was 4% (92/2263). The highest HIV/Kala-azar coinfection rate was 15% in 2009 and the lowest was 4.8% in 2014. Conclusion: Visceral leishmaniasis was highly prevalent in the study area. There was high kala-azar mortality rate and majority of deaths were unrecognized. Prevalence rate of VL-HIV co-infection and relapse was higher at MSF Abdurafi kalazar treatment center in West Armachiho district. Ministry of health should strengthen prevention and control mechanisms of kala-azar. Ministry of health and MSF Holland should conduct further studies on the cause of death among kala-azar patients, because there may be drug toxicity or other complications

Perceived barriers to health care for residents in vulnerable urban centers of Ethiopia

Background: Slums in urban settings are fast expanding and unprecedented proportions of urbanites are now living in slums, with the compromised provision of health services. Slum-dwellers in urban settings often face multifaceted barriers to accessing available health services. There is a paucity of evidence on identifying barriers in vulnerable urban centers of Ethiopia. This study aims to explore the barriers to the use of health services in slum urban settings of Ethiopia. Methodology: A qualitative study using in-depth and key informant interviews were conducted in 13 selected John Snow, Inc. (JSI) program operational urban areas of Ethiopia. Data were collected from community members, community opinion leaders, Urban Health Extension Professionals, and urban area health office representatives. The interviews were transcribed by data collectors and analyzed using a thematic content analysis approach. Accordingly, individuals, community- and health facility-level barriers were key themes under which findings were categorized. Results: Findings revealed that barriers to health service use at the individual level include limited awareness about health problems, competing priorities and limited capacity to pay for services when referred. Institutional-level barriers include limited medical supplies, and a lack of passion, respect, and positive attitudes on the part of health service providers. Barriers at the community level include a lack of shared understanding of the problems, services, and the community’s established values in relation to the problems and services. Conclusions: The provision of (maternal) health services in slums in Ethiopia’s urban settings is affected by different barriers that work in tandem. The improvement of health service provision in slum settings requires multiple interventions, including strengthening the health system’s responsiveness to health care demand. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):04-11] Keywords: Barriers, slum sections of urban centers, community, service provider

Health service access, utilization and prevailing health problems in the urban vulnerable sections of Ethiopia

Background: Currently, one-third of urban residents in Africa and Asia reside in slum settings with a compromised state of health, and this proportion is increasing at an alarming rate. In Ethiopia, it is estimated that 70-80% of the urban population lives in settings that are believed to be slums and most of the urban population has no access to improved sanitation. Though there is still a limitation on proper urban health profile data, there is evidence of vulnerability to a wide range of health-related problems in the country, including HIV. Hence, this study aimed to generate evidence on access to and utilization of health services, particularly by mothers and children, and the prevailing health problems of vulnerable sections of the urban population. Methods: A total of 115 urban vulnerable sections were identified in 46 towns in five regions (Amhara; Oromia; Tigray; Southern Nations, Nationalities, and Peoples’ (SNNP); and Harari) and two city administrations (Addis Ababa and Dire Dawa) where John Snow Inc. (JSI) urban centers are located. A cross-sectional household survey design was conducted among identified urban vulnerable sections of the population on 10–20 May 2017. A total of 1,220 households were included, based on a two-stage stratified sampling method. The analysis used mainly descriptive statistics and SPSS version 21 software was used for the analysis. Results: The mean age of the respondents was 43.2 (SD=14.8) years, and females accounted for 75% of all participants. The average time (SD) from the households to the health facility is 18 (±11) minutes. One month prior to the study, 32.6% of the household members reported having had some form of illness and 44% of them visited a health center and 36% a hospital. More than two thirds (68.6%) of women gave birth at a health facility and most (70.1%) births were assisted by a skilled provider. Nearly two thirds (63.4%) of women received a postnatal check-up. In 7.6% of the households, diarrhea occurred among children under 5 in the past two weeks, and 88% sought advice or further treatment. Non-communicable diseases (NCDs) account for the largest share of causes of morbidity among adults (29%) and death was observed in 8.4% of the households in the last three-year period prior to the survey. The most perceived causes of death in households were kidney disease, hypertension, heart disease, and other NCDs (65%). Conclusions: Health facilities are located near households. However, a significant proportion of mothers are still giving birth at home and more than a third of the births are attended by non-skilled attendants. Postnatal care utilization remained a challenge. NCDs were found to be the most prevailing problem among adults in the households and most of the deaths were also related to NCDs. Social changing interventions are recommended so that women have trust to deliver at facilities and postnatal visits are increased. Targeted preventive interventions are also essential to avert the growing burden of NCDs and others in the urban vulnerable sections. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):12-23] Keywords: Health service, access, health problem, vulnerable sections, Ethiopi

Prevalence and risk factors for initiating alcohol and tobacco consumption in adolescents living in urban and rural Ethiopia

© 2019 The Authors Objectives: African countries are potential high growth markets for the alcohol and tobacco industries. This study aimed to identify exposures that are associated with initiating use of alcohol and tobacco products in young people living in Ethiopia. As televised football and Internet viewing are media through which products can be promoted to this population efficiently, these risk factors were of particular interest. Study design: This is a cross-sectional study. Methods: Data were collected using a self-administered questionnaire of 3967 children aged 13–19 years in 20 high schools in urban and rural Ethiopia on consumption and risk factors for alcohol and tobacco use in 2016, as well as exposure to potential sources of advertising. Results: Eight percent of respondents reported having ever smoked and 3% were current smokers. Twenty-nine percent reported ever having used alcohol, and 14% were current users. Risk factors for ever smoking included father smoking (odds ratio [OR] 1.95; 95% confidence interval [CI]: 1.21 to 3.15), mother smoking (OR 3.90; 95% CI: 1.63 to 9.33), best friend smoking (OR 5.86; 95% CI: 4.31 to 7.96) and home Internet access (OR 1.75; 95% CI: 1.35 to 2.27). There was a very strong positive association between ever having smoked cigarettes and ever having tried alcohol (P < 0.001). Risk factors for currently drinking alcohol included father drinking (OR 1.45; 95% CI: 1.05 to 2.01), mother drinking (OR 2.00; 95% CI: 1.44 to 2.77), home Internet access (OR 1.53; 95% CI: 1.24 to 1.90) and regular watching of televised football (OR 2.44 compared to those who do not; 95% CI: 1.58 to 3.78). Conclusions: As in rich countries, tobacco and alcohol use among Ethiopian teenagers increases among those exposed to family and peer use but are also more common among those accessing the Internet and, for alcohol, those watching televised football. The effect of watching televised football on alcohol use, at least, is likely to be due to exposure to advertising

An Emerging Problem of Shisha Smoking among High School Students in Ethiopia

Shisha smoking is also known as hookah, water pipe, goza, and nargile. Shisha use among the young is increasing globally. Shisha smoke results in a high concentration of carbon monoxide, tar, nicotine, and heavy metals which can be toxic to humans, especially with chronic exposure. This study aims to determine the prevalence and risk factors of shisha smoking among in-school adolescents in Ethiopia. Four regional states in Ethiopia (Oromia, Amhara, Southern Nations, Nationalities, and Peoples’ Region, Tigray) and the capital city (Addis Ababa) were the study areas. A two-stage cluster sampling approach was employed to produce a representative sample. From the sampling frames in the study areas, 36 high schools were selected randomly. A multi-level logistic regression analysis was used to account for cluster-specific random effects, the effect of individuals’, and school-level variables for ever-use of shisha. A total of 3355 secondary school grade 9 and 10 students aged between 13 and 22 years took part in this study. A total of 86 (2.6%) and 20 (0.6%) of the study participants, reported that they had ever smoked or were current smokers of shisha, respectively. Of all study participants, 38.6% perceived shisha as less harmful than cigarettes and 48.5% reported that they do not know which was more harmful to health. Students were more likely to ever use shisha if they had friend/s who smoke shisha (AOR = 16.8, 95% CI: 6.4–44.3), ever smoked cigarettes (AOR = 8.2, 95% CI: 3.4–19.8), ever used khat (AOR = 4.2, 95% CI: 1.9–10.4), ever used marijuana (AOR = 3.9, 95% CI: 1.4–11.1), ever used smokeless tobacco (AOR = 3.1 95% CI: 1.1–8.4), and students had received income from their parents (AOR = 3.1 CI: 1.1–8.8). Prevalence of ever and current use of shisha among high school students is low in Ethiopia compared to many countries in Africa. The majority of adolescents perceived shisha as less harmful to health than cigarette smoking. Health education about the harmful effects of shisha should be delivered to adolescents, along with information on other substances like khat, cigarettes, marijuana, and smokeless tobacco to prevent initiation of substance use

Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review

Objectives This systematic review aims to evaluate the evidence of non-pharmacological strategies to improve blood pressure (BP) control in patients with hypertension from African countries. Design We performed a systematic review and searched Medline, Central, CINAHL and study registers until June 2020 for randomised studies on interventions to decrease BP of patients with hypertension in African countries. We assessed the study quality using the Cochrane risk of bias tool and narratively synthesised studies on non-pharmacological hypertension interventions. Setting We included studies conducted in African countries. Participants Adult African patients with a hypertension diagnosis. Interventions Studies on non-pharmacological interventions aiming to improve BP control and treatment adherence. Outcomes Main outcomes were BP and treatment adherence. Results We identified 5564 references, included 23 with altogether 18 153 participants from six African countries. The studies investigated educational strategies to improve adherence (11 studies) and treatment by healthcare professionals (5 studies), individualised treatment strategies (2 studies), strategies on lifestyle including physical activity (4 studies) and modified nutrition (1 study). Nearly all studies on educational strategies stated improved adherence, but only three studies showed a clinically relevant improvement of BP control. All studies on individualised strategies and lifestyle changes resulted in clinically relevant effects on BP. Due to the type of interventions studied, risk of bias in domain blinding of staff/participants was frequent (83%). Though incomplete outcome data in 61% of the studies are critical, the general study quality was reasonable. Conclusions The identified studies offer diverse low-cost interventions including educative and task-shifting strategies, individualised treatment and lifestyle modifications to improve BP control. Especially trialled physical activity interventions show clinically relevant BP changes. All strategies were trialled in African countries and may be used for recommendations in evidence-based guidelines on hypertension in African settings

Perceived barriers to timely treatment initiation and social support status among women with breast cancer in Ethiopia

Timely care is essential to increase breast cancer survival. However, patients in Ethiopia still face multilevel barriers on their pathway to timely treatment initiation. This cross-sectional study at Tikur Anbessa Specialized Hospital Oncology Unit in Addis Ababa assessed systemic treatment initiation intervals of breast cancer patients and quantified the impact of socio-demographic and clinical factors, perceived barriers, and the patients´ perceived social support status on timely systemic treatment initiation (chemotherapy or hormonal therapy). A structured questionnaire was designed based on Pechansky´s “Concept of Access”. Applying simple and multivariate logistic regression we analysed the influence of patients´ characteristics as well as their perceived barriers on timely treatment initiation. We measured social support with the Multidimensional Score of Perceived Social Support (MSPSS) and used the Wilcoxon Rank-Sum Test to assess its relationship with timely treatment initiation. Of 196 patients included into the study, 53% received systemic treatment within 90 days of their pathological diagnosis–the median treatment initiation interval was 85 days (IQR 123.5). Older women and patients diagnosed at late stages had higher odds of timely treatment initiation. Not being able to pay for services and lack of transport were most often perceived as barriers towards timely care. However, none of the perceived barriers showed a substantial influence on timely treatment initiation in the multivariate regression model. The patients´ perceived social support was found to be high, with an average MSPSS score of 73 out of 84 (SD 13,63). No impact of the perceived social support status on timely treatment initiation was found. The percentage of breast cancer patients waiting longer than 90 days from pathological diagnosis to systemic treatment initiation in Ethiopia remains unacceptably high. While women generally feel well supported by their social environment, costs and accessibility of treatment are perceived to be major barriers towards timely treatment initiation

Prevalence and risk factors for tobacco, khat and alcohol consumption among high school students in Ethiopia

Background: Tobacco, khat, alcohol and marijuana are the main risk factors for non-communicable diseases. There are limited studies on substance use in Ethiopia, especially among secondary school students. This study aims to determine the epidemiology of substance use among secondary school students in Ethiopia. Methods: This cross-sectional study was conducted in March, 2020 in four large regions of Ethiopia and the capital Addis Ababa. We collected data from 3,355 grade 9 and grade 10students in 36 randomly selected high schools. Data were collected on the use of tobacco, khat, alcohol and other substances. Mixed effect logistic regression models were fitted to determine the predictors of cigarette smoking.Results: 157 (4.7%) of the participants ever smoked cigarettes and 81 (2.4%) were current smokers. 106 (3.2%) ever used smokeless tobacco, 1,342 (41.8%) had ever drunk alcohol, 290(8.7%) ever used khat, 137 (4.8%) chewed khat regularly and 76 (2.3%) ever used marijuana. There was a significant regional variation in substance use patterns; cigarette and khat use was the highest in Southern regions, whereas alcohol use was highest in the Northern regions. Availability of cigarette and khat shops within a 100-meter radius of the school compound was reported by 1,229 (37.5%) and 816 (25%) students, respectively. Three hundred fifty-four(10.9%) students had ever seen someone smoking a cigarette in the school compound. Ever use of smokeless tobacco (Adjusted Odds Ratio (AOR)=9.4, 95%CI: 4.9-17.9), ever use of shisha(AOR=8, 95% CI: 3.9-16.3), ever use of khat (AOR=4.1, 95%CI: 2.5-6.8), ever use of alcohol(AOR= 2.3, 95%CI: 1.4-3.7), having a friend who smoked cigarette (AOR=2, 95%CI: 1.2-3.5),and ever seeing someone smoking a cigarette in the school compound (AOR=1.9, 95%CI: 1.1-3.4) were associated with ever use of cigarettes.Conclusions: Substance use prevalence in Ethiopia has regional variations and prevention strategies should be tailored to the needs of the regions. Although this study reported a lower prevalence of cigarette smoking, students were able to access cigarettes and khat in nearby school areas. The existing tobacco control laws that prohibit selling tobacco products to children and adolescents under 21 years of age and ban establishing tobacco shops close to school compounds should be enforced

Survival and predictors of breast cancer mortality in South Ethiopia: A retrospective cohort study

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity. Methods: A hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit. Results: The study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7–23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30). Conclusion: Beyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women