Alcohol advertisement prohibition: making it work in Ethiopia

Alcohol consumption is associated with communicable and non-communicable diseases. The World Health Organization estimates that there are 3 million deaths globally every year in connection with alcohol consumption, and 13.5% of deaths among the 20-39 years age group are related to harmful alcohol use (1). In addition, alcohol use poses a major economic burden and decreases the quality of life of consumers and society at large (2). A systematic review of the economic impact of alcohol consumption from 12 high-income countries shows that alcohol is estimated to cost between 0.45-5.44% of Gross Domestic Product (GDP) in direct and indirect costs, which is a substantial amount (3). Despite the costly effects of alcohol consumption, alcohol advertisements are commonly seen in the media worldwide, including in Ethiopia

Editorial: Sustainable Development Goals (SDGs) and HIV/AIDS prevention and control: Call to sustain the momentum

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Determinants of self and public stigma and discrimination against people with mental illness and their family in Jimma zone, Southwest Ethiopia

Background: Stigma can be detrimental to the quality of life, as well as the treatment and rehabiltation process of people with mental illness. The purpose of this study was to measure the extent and determine correlates of public and self-stigma against people with mental illness (PWMI) and their families in Jimma Zone, Southwest Ethiopia. Methods: Community and institution based quantitative and qualitative cross-sectional studies were conducted among 845 randomly selected community members at GGFRC, consecutive 422 PWMI and 422 family members of PWMI at Jimma University Specialized Hospital. Univariate, bivariate and multivariate linear regression analyses were done. Results: The mean scores of public stigma against PWMI and their family members were 2.62 (+0.34) and 2.16 (+0.49), respectively, on a range of 1 to 5. The mean self-stigma score among PWMI, on a range of 1 to 4, was 2.32 (+0.30). Place of residence, belief in the supernatural, psychosocial and biological explanations of mental illness were associated with stigma towards PWMI and family members of PWMI. Level of education and income predicted PWMI public stigma. A higher number of perceived signs of mental illness was correlated with lower stigma against family members of PWMI. Females, individuals with history of traditional treatment, individuals experiencing higher number of drug side-effects, and individuals who subscribed to more signs and supernatural explanations had significantly higher levels of self-stigma. In contrast, patients with higher education level and higher self esteem showed significantly lower levels of self-stigma. Supporting supernatural explanations of mental illness was associated with greater care-givers’ self-stigmatization. Conclusion: High public stigma against PWMI and high levels of patients’ self-stigma were found. Care-givers demonstrated reluctance to be identified with PWMI. Systematic forms of discrimination against PWMI and their family members were identified. PWMI and their family members faced behavioral and structural challenges. Thus, reducing stigma against patients may help to reduce stigma against family members. Developing strategies to improve patients’ self esteem, and developing policies and guidelines about mental illness may be helpful in reducing stigma. Effective intervention strategies that target patients, their families, as well as the public need to be designed to reduce stigma

Determinants of self and public stigma and discrimination against people with mental illness and their family in Jimma zone, Southwest Ethiopia

Background: Stigma can be detrimental to the quality of life, as well as the treatment and rehabiltation process of people with mental illness. The purpose of this study was to measure the extent and determine correlates of public and self-stigma against people with mental illness (PWMI) and their families in Jimma Zone, Southwest Ethiopia. Methods: Community and institution based quantitative and qualitative cross-sectional studies were conducted among 845 randomly selected community members at GGFRC, consecutive 422 PWMI and 422 family members of PWMI at Jimma University Specialized Hospital. Univariate, bivariate and multivariate linear regression analyses were done. Results: The mean scores of public stigma against PWMI and their family members were 2.62 (+0.34) and 2.16 (+0.49), respectively, on a range of 1 to 5. The mean self-stigma score among PWMI, on a range of 1 to 4, was 2.32 (+0.30). Place of residence, belief in the supernatural, psychosocial and biological explanations of mental illness were associated with stigma towards PWMI and family members of PWMI. Level of education and income predicted PWMI public stigma. A higher number of perceived signs of mental illness was correlated with lower stigma against family members of PWMI. Females, individuals with history of traditional treatment, individuals experiencing higher number of drug side-effects, and individuals who subscribed to more signs and supernatural explanations had significantly higher levels of self-stigma. In contrast, patients with higher education level and higher self esteem showed significantly lower levels of self-stigma. Supporting supernatural explanations of mental illness was associated with greater care-givers’ self-stigmatization. Conclusion: High public stigma against PWMI and high levels of patients’ self-stigma were found. Care-givers demonstrated reluctance to be identified with PWMI. Systematic forms of discrimination against PWMI and their family members were identified. PWMI and their family members faced behavioral and structural challenges. Thus, reducing stigma against patients may help to reduce stigma against family members. Developing strategies to improve patients’ self esteem, and developing policies and guidelines about mental illness may be helpful in reducing stigma. Effective intervention strategies that target patients, their families, as well as the public need to be designed to reduce stigma

Polysubstance use behavior among the male population in Ethiopia: Findings from the 2016 Ethiopia Demographic and Health Survey

Background: Substance use is predominantly associated with male behavior and is becoming one of the major public health challenges across the globe, including in Ethiopia. The purpose of this study was to estimate the magnitude and predictors of polysubstance use behavior among males in Ethiopia. Methods: Data were extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). From a total of 12,688 male participants in the EDHS, a sample was extracted of 7,931 males who used at least one substance (alcohol, khat or tobacco) during the time of the survey. Those who used more than one substance were considered as polysubstance users, which was the outcome of interest. Descriptive statistics was computed and displayed with tables and graph. Logistic regression was carried out to identify predictors of polysubstance use, and statistical significance was declared at a 95% confidence level. Results: Of the total sample of 12,688 males in the 2016 EDHS, 7,931 (62.5%) were currently using at least one substance. Regional distribution of current substance users shows that Amhara (18.5%), Tigray (14.2%) and Oromia (12.8%) have the highest percentage of substance users, respectively. Among the current any substance users, 15.0% use cigarettes daily or on some days – 74.7% of these are daily users. Nineteen per cent of current male substance users in Ethiopia are polysubstance users. The main substances consumed are alcohol only (53.1%), followed by khat only (25.9%). Polysubstance use behavior can be predicted by residence (urban residence: OR: 1.78; CI: 1.35, 2.34), educational status (secondary education: OR: 1.50; CI: 1.19, 1.89) and marital status (no longer living together: OR: 2.85; CI: 1.58, 5.15). Region, religion, wealth status, age, family size and media exposure are other factors significantly associated with polysubstance use behavior. Conclusions: Polysubstance use behavior among males is widespread in all regions of the country. Socio-demographic factors and access to media are predictors of polysubstance use. Therefore, in addition to law enforcement such as prohibition of advertising, there is a need to investigate underlying genetic, structural, policy and behavioral determinants of polysubstance use so that holistic interventions can be designed to target multiple substance use simultaneously. [Ethiop. J. Health Dev. 2020; 34(3):171-180] Key words: Alcohol, cigarettes, EDHS, Ethiopia, khat, males, polysubstance use, substance us

Risky driving behaviors for road traffic accident among drivers in Mekele city, Northern Ethiopia

<p>Abstract</p> <p>Background</p> <p>Due to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers.</p> <p>Methods</p> <p>A quantitative cross-sectional study with a sample size of 350 drivers was conducted in April 2011. The study was conducted among Taxi, Bajaj (three tire vehicles) and private owned car drivers. After proportion to size allocation for Taxi (75), Baja (103) and private owned car (172) drivers, we used systematic random sampling method to identify illegible study subjects. Data was collected with face to face interview using a pretested questioner. Univariate, bivariate and multivariate analysis was done using SPSS version 16.</p> <p>Results</p> <p>The mean age of the respondents was 28.7 (SD 9.9). Majority were 339 (96.9%) males. Significant number of the study subjects 233 (66.6%) had risky driving behaviors. More than a quarter 100 (28.6%) had less knowledge about basic traffic signs. Majority of drivers 181 (51.7%) had negative attitude towards risky driving behaviors. Significant percent of them 148 (42.3%) had a habit of using mobile phone while driving vehicle and 28 (9.7%) had experience of driving after drinking alcohol. All the Bajaj, 97(62.6%) house car and 58(37.4%) taxi unfasten their seat belt while driving. Majority 303 (86.6%) followed the recommended speed limit of driving. About 66 (18.9%) of them had experience of punishment or warning by traffic polices in the previous 1 year and 77 (22%) ever had car accident while driving.</p> <p>Conclusions</p> <p>Drivers of secondary education and with high average monthly income were more likely to have risky driving behavior. Having supportive attitude towards risky driving behaviors and not getting advice about risky driving from significant others increases the likelihood of developing risky driving behavior. Interventions targeted at developing negative attitude towards risky driving behaviors on drivers and significant others should be implemented to bring positive behavior change. The interventions need to be segmented with educational status and income.</p

Ethnomedicine claim directed in Silico prediction of anticancer activity

Background: The merits of ethnomedicine-led approach to identify and prioritize anticancer medicinal plants have been challenged as cancer is more likely to be poorly understood in traditional medicine practices. Nonetheless, it is also believed that useful data can be generated by combining ethnobotanical findings with available scientific studies. Thus, this study combined an ethnobtanical study with ligand based in silico screening to identify relevant medical plants and predict their anticancer potential based on their phytoconstiutents reported in scientific literatures.Methods: First, relevant medicinal plants were identified through an ethnobotanical survey. A list of phytochemicals was prepared based on literature review of articles which reported on the natural products of identified medicinal plants. Then, their phytochemicals were subjected to in silico evaluation, which included a hybrid score similarity measure, rule of five, Ghose–Viswanadhan–Wendoloski (GVW)-indices and structural features criteria, to predict their anticancer activity and drugability.Results: A total of 18 medicinal plants and 265 phytoconstituents were identified. The natural product pool constituted 109(41.13%) terpenoids, 67(25.28%) phenolics, 29(10.94%) simple and functionalized hydrocarbons, 26(9.81%) alkaloids, 25(9.43%) glycosides and 9(3.40%) compounds belonging to different phytochemical classes. The similarity measure using CDRUG identified 34(12.73%) phytochemicals with high (p-Value &lt; 0.05) and 35(13.21%) with moderate possibility (p-Value &lt; 0.1) of anticancer activity. In fact, three of the predicted compounds had the same structure with known anticancer compounds (HSCORE=1). The 80% GVW-indices based antineoplastic drugabilityranges were all mate by 25 of the predicted compounds. Predicted compounds were also shown to have ring structures and functional groups deemed important for anticancer activity. Conclusions: Given the findings, there is a promising anticancer activity by thetraditionally used medicinal plants and a potential for the predicted phytochemicals to be pursued as possible hits or me-too drugs.Keywords: Ethnobotany, phytochemicals, in silico, anticancer, medicinal plant

Burnout Status at Work among Health Care Professionals in aTertiary Hospital

Background: Burnout is a physical, physiological and psychological stress reaction syndrome Caused by long-term exposure to intense work-related emotional and interpersonal pressures. There is no evidence on the issue in Ethiopian setting.Methods: An institution based cross-sectional study design was conducted on 403 health care providers. Burnout was detected using Copenhagen’s burnout inventory tool. Other structured questionnaire on work-related condition and substance use habits was used to collect data. Binary logistic regression was used to identify the associated factors of burnout at work.Result: Of all the study participants, 36.7% scored above the mean level of burnout. Highest prevalence (82.8%) of burnout status was found among nurses. The least prevalence of burnout was observed among laboratory technicians which was 2.8% (n=4). Job insecurity, history of physical illness, low interest in profession, poor relationship status with managers, worry of contracting infection or illness and physical/verbal abuse were found to be predictors of burnout.Conclusion: The prevalence of burnout at work was found to be high. The predictors were job insecurity, history of physical illness, low interest in profession, poor relationship status with managers, worry of contracting infection or illness and physical/verbal abuse.Keywords: Burnout, Health professionals, Occupational health, Work related factor

Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting

Background: Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting. Methods: A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity. Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach’s alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors. Conclusion: The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.Garumma Tolu Feyissa, Lakew Abebe, Eshetu Girma, Mirkuzie Woldi

Barriers and facilitators of ART adherence in Hawassa town, Southern Ethiopia: A grounded theory approach

Background: Antiretroviral therapy (ART) has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis and improve quality of life. Patient’s adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients’ adherence to ART and improve the service. This study aims to explore patients’ and health care professionals’ views about factors that facilitate and hinder adherence to ART among adult HIV patients.Methods: A qualitative grounded theory study using non-participant observation; and in-depth interview with 23 ART users and 5 health professionals were carried out at two health facilities that serve a large number of HIVpositive individuals in Hawassa town, Southern Ethiopia. The study was conducted from February to April 2014. Simultaneous data collection and analysis was conducted and taped Notes were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. To manage the overall coding process, Atlas.ti (v.7) software was used.Results: The commonest barriers to adherence-included poverty, substance misuse, forgetfulness and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers.Conclusion: The study revealed a range of barriers to adherence including individual, medical, environmental and economic related factors. The findings from our study can be used to inform the development of effective interventions that address the barriers and facilitators of ART adherence in Ethiopia. Priority should be given to improving adherence by alleviating financial constraints to ART adherence, better access to treatment services, education and counseling to tackle culture related obstacles, stigma and discrimination. [Ethiop. J. Health Dev. 2016;30(2):66-77]Keywords: Grounded theory, ART, HIV/AIDS, qualitative researc