Barriers to Socio-economic Opportunities in Africa: An e-Government Perspective

Various barriers to socio-economic opportunities in Africa are explored though e-Government as a lens of study. Using grounded theory methodology, scholarly literature on e-Government in Africa has been analyzed to model various barriers. The research is expected to serve as a scholarly reference for decision-makers in the private and the public sector organizations, as well as policymakers, for making decisions about design, development and execution of e-Government initiatives in Africa

Thyroid Hormone Tests Ordering Practice and Cost-Effectiveness in Samples Referred to International Clinical Laboratories from Addis Ababa Health Facilities

BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves’ disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients’ samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL.RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal.CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common

Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and metaanalysis

Background Late presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care. Methods Quantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome:late HIV testing',late HIV diagnosis' andlate presentation for HIV care after testing'. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta-Analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value. Results Ten studies from low-And middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-Analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6±3.6, I2 = 79%). Conclusions High perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should play a key role in informing and counselling patients on the benefits of early HIV testing or early entry to HIV care. Additionally, linking the systems and positive case tracing after HIV testing should be strengthened

Evaluation of static and dynamic land use data for watershed hydrologic process simulation: A case study in Gummara watershed, Ethiopia

Land Use Land Cover (LULC) change significantly affects hydrological processes. Several studies attempted to understand the effect of LULC change on biophysical processes; however, limited studies accounted dynamic nature of land use change. In this study, Soil and Water Assessment Tool (SWAT 2012) hydrological model and statistical analysis were applied to assess the impacts of land use change on hydrological responses such as surface runoff, evapotranspiration, and peak flow in Gummara watershed, Ethiopia. Moreover, the effects of static and dynamic land use data application on the SWAT model performance were evaluated. Two model setups, Static Land Use (SLU) and Dynamic Land Use (DLU), were studied to investigate the effects of accounting dynamic land use on hydrological responses. Both SLU and DLU model setups used the same meteorological, soil, and DEM data, but different land use. The SLU setup used the 1985 land use layer, whereas the DLU setup used 1985, 1995, 2005, and 2015 land use data. The calibration (validation) results showed that the model satisfactorily predicts temporal variation and peak streamflow with Nash Sutcliffe Efficiency (NSE) of 0.75 (0.71) and 0.73 (0.71) in the DLU and SLU setups, respectively. However, the DLU model setup simulated the detailed biophysical processes better during the calibration period. Both model setups equally predicted daily streamflow during the validation period. Better performance was obtained while applying the DLU model setup because of improved representation of the dynamic watershed characteristics such as curve number (CN2), overland Manning's (OV_N), and canopy storage (CANMX). Expansion of agricultural land use by 11.1% and the reduction of forest cover by 2.3% during the period from 1985 to 2015 increased the average annual surface runoff and peak flow by 11.6 mm and 2.4 m3/s, respectively and decreased the evapotranspiration by 5.3 mm. On the other hand, expansion of shrubland by 1% decreased the surface runoff by 1.2 mm and increased the evapotranspiration by 1.1 mm. The results showed that accounting DLU into the SWAT model simulation leads to a more realistic representation of temporal land use changes, thereby improving the accuracy of temporal and spatial hydrological processes estimation

Vitamin A deficiency status in Tigray Region, Ethiopia, 1996

Abstract: A survey was conducted to determine the prevalence of xerophthalmia in Alaje and Samre weredas of Tigray Region, Northern Ethiopia, where EPI-plus and Wereda Integrated Basic Service (WIBS) approaches are being launched to prevent and control vitamin A deficiency. A total of 5,253 preschool children (PSC) were clinically examined between October and November, 1996 for ocular signs of xerophthalmia. Blood samples were drawn from 248 PSC for serum retinol levels(SRL). The overall prevalence rates of night blindness (XN) and Bitot's spot (X B) for both weredas were 1 0.9% and 1.5%, respectively, with a higher prevalence rate in males than females (53 vs 26). Alaje wereda(EPI-plus) had XN=21(0.8%) and X B=38(1.4%), and Samre wereda (WIBS) had 1 XN=25(1.0%) and X B=41(1.7%). No sex difference was seen in the prevalence rate of corneal 1 xerosis and keratomalacia (0.4%). The most affected age groups were children between five and six years of age. Both weredas showed the distribution of serum retinol levels to be deficient in 21(16.7%) in Samre and 19(15.5%) in Alaje, and low in 60(47.6%) in Samre and 57(46.7%) in Alaje. Low SRL is found to be highest among children between five and six years of age in males and between two to three years of age in females in both weredas. The high prevalence rate of X B 1 (three times higher than the WHO cut-off point), and the low level of serum retinol value found in this study indicates the need and urgency for the continuation of the aforementioned strategies of vitamin A deficiency control program launched in the Region until their impact is further evaluated. [Ethiop. J. Health Dev. 1999;13(2):87-91

Hydrologic modeling of the Iroquios River watershed using HSPF and SWAT

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Flood protection and management for the lower Illinois River system, phase III: real-time simulation of floods with managed LDD storage options

"Prepared for the Office of Water Resources, Illinois Department of Natural Resources.

Hydrology of the Big Creek Watershed and its influence on the Lower Cache River

"March 2001.""Contract report 2001-06.

Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study

Tuberculosis (TB) is an infectious disease which causes about two million deaths each year. In 1993, the World Health Organization (WHO) declared TB to be a “Global Emergency” due to an increasing number of TB cases and a rise in multidrug resistant cases in the developed world. Treatment interruption was considered one of the major challenges. WHO introduced the current TB control program DOTS (directly observed treatment, short course) as the tool to control the disease. To prevent further development of resistance against anti-TB drugs it was decided to observe each patient taking their daily dose of medication. The overall aim of this thesis is to explore how patients and health workers perceive and manage TB symptoms and treatment in a high-endemic and a low-endemic setting in the era of DOT(S). The data is based on fieldwork, including in-depth interviews and focus groups with TB patients and health workers, in Addis Ababa, Ethiopia (2001-2002) and in Oslo/Akershus, Norway (2007-2008). We found that people’s interpretation and management of TB symptoms is influenced by cultural, social and economic factors. TB was, in both contexts, associated with poverty, and subsequently with a disease that affects certain countries or certain segments of a population. TB was viewed as a severe disease in both contexts, but there was variation between individuals to what extent one considered oneself as a likely victim. In the absence of circumstantial causes, such as poverty, patients in a lowendemic setting like Norway, found it difficult to understand why they had developed the disease. There was scarce knowledge about the fact that the disease could be latent. Awareness of early symptoms, such as persistent cough, was low in both contexts. Perceptions of vulnerability, together with the presence or absence of socio-economic barriers or enablers influenced at what time patients would seek help. The study suggests that health personnel lacked awareness or misinterpreted early symptoms of TB. In Ethiopia, lay categorizations of early TB symptoms converged with diagnostic practices in parts of the professional health sector. The diagnostic process could endure for many months after patients’ first contact with the health services. Similarly, in Norway, we found that patients’ interpretations of early symptoms often were confirmed in the meeting with health personnel. The consequences were prolonged diagnostic processes. The study shows that patients’ ability to manage TB treatment is a product of dynamic processes, in which social and economic costs and other burdens interplay over time. A decision to interrupt treatment can be shaped by past struggles and accrued costs; in which seems financially, socially or emotionally unbearable at the moment of treatment interruption. The burdens related to DOT could also be significant, in patients who did not interrupt treatment. Patients in both Ethiopia and Norway experienced an authoritarian and rigid practice of DOT, which made it difficult to simultaneously attend to demands related to treatment and demands related to other areas of life. The most vulnerable patients, such as those without permanent jobs, suffered from high economic, social and emotional costs. In conclusion, health personal need more knowledge about typical and atypical symptoms of TB. In low-endemic settings doctors need to be trained to adjust their level of suspicion to the migration history of the patient. In high-endemic settings one should be aware that health personnel may understand and manage TB within a traditional perspective. Patients in both high- and low-endemic contexts need concrete information about the cause of TB, how it is transmitted, how symptoms can be manifested, how the disease can progress and how it can be cured. The study indicates that inequalities that predispose for TB may be reinforced in the patient’s interaction with the health services due to a rigid, disempowering practice of DOT. Subsequently, DOT per se may add to the chain of structural barriers that patients have to overcome to access and complete treatment. To ensure that TB patients complete treatment one must address the coexisting and interacting crises that follow a TB diagnosis. This could require TB programs to adopt a more holistic approach. Measures that secure early diagnosis may reduce some of the physical, psycho-social and economic costs patients face while undergoing treatment. Measures that empower patients to participate in their own health care may avoid disempowering and humiliating practices