Things that take from people’s bodies: rumours about minimally invasive tissue sampling and evil spirits in ethiopia

In this paper we describe how the innovative technique of minimally invasive tissue sampling (MITS) and the researchers associated with it came to represent the fears, anger, and suspicions of a community in Eastern Ethiopia. MITS was developed to lessen the uncertainty over causes of death in low- and middle-income countries (Bassat et al. 2016). It is a medical procedure where a core biopsy instrument is used to extract numerous small tissue samples from a pre-defined set of organs (brain, lung, heart, liver, bone marrow) in deceased children under 5 and stillbirths. Additionally, MITS practitioners collect blood, urine, stool, and cerebral spinal fluid, take nasopharyngeal and oropharyngeal swabs, and include measurements and several pictures of the body to identify any abnormalities. In the study site, MITS has become more than just an act of extracting samples. Instead, it is a social process that begins when the research team learns about the death of a child and ends when the child is buried. Furthermore, the act of sample taking has come to represent the underlying fears, anger, and suspicions in the com-munity about organ and blood theft, and those researchers associated with it – whether social scientists or histopathologists – have become the embodiment of an evil spirit called tuqatta, who survives on blood and organs, and conducts ritual sacrifice by offering the blood of its victims to spiritual ancestors. We suggest that the tuqatta embodies the strongly felt suspicion that the MITS intervention is not there for people’s benefit, but rather that it is taking something from them. The emergence of the tuqatta in the research site highlights the vulnerability that people feel in relation to this global health medical intervention. We conclude by arguing that local frames of understanding should not be dismissed as ‘rumours’ or simply as something to overcome in health research; rather, they require serious attention and indicate the need for open dialogue between researchers and the public

Khat chewing habit as a possible risk behaviour for HIV infection: a case-control study

Background: The use/abuse of psychoactive drugs such as khat leaves (Catha edulis) are believed to alter one's moods or emotional state either through the sustained release or inhibition of neurotransmitters, thereby enhancing or dampening the response of the individual. Most people whose thinking are warped by continued drug use may not be able to see the harm resulting from their actions. Thus, there has been a strong linkage between drug use and casual or unsafe sexual practice despite the serious concern about HIV infection. Objective: Khat chewing is known to be a widespread habit in Ethiopia. This study is, thus, aimed at investigating whether or not the use of this psychostimulant alone or in conjunction with other behaviors associated with its use constitutes a risk behavior that accelerates the spread of HIV infection. Methods: A case-control study involving 850 human subjects, i.e. 425 HIV positives (cases) and 425 HIV negatives (controls) was conducted using rapid test algorithm and/or western blot method for determination of HIV status. Both groups were interviewed about their probable khat chewing habits, alcohol intake, multiple sexual practice, and the like, using a structured questionnaire. The data were analysed using SPSS/PC + statistical software.Results: Risk behaviors for HIV infection such as khat chewing in conjunction with alcohol intake and casual sex were observed more in people with HIV than in the control group. Khat chewing was significantly associated with multiple sexual practice (OR = 4.03, 95% CI = 3.02, 5.39), which in turn was strongly linked with HIV cases (OR = 3.52, 95% CI = 2.64, 4.69). Thus, more than the non-chewers, khat chewers constituted significantly higher number of HIV cases (OR =2.32, 95% CI = 1.75, 3.07).Conclusion/Recommendations: Khat chewing is a risk behavior for the spread of HIV infection. Mainstreaming of khat control into national development planning initiatives is recommended.The Ethiopian Journal of Health Development Vol. 19(3) 2005: 174-18

Using traditional healers to treat child malnutrition: a qualitative study of health-seeking behaviour in eastern Ethiopia

Background: Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children’s malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents’ treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people’s health-seeking behaviour. Methods: The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers’ assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory. Results: Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition. Conclusions: Through an exploration of people’s own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres

Investigating the feasibility of child mortality surveillance with postmortem tissue sampling: generating constructs and variables to strengthen validity and reliability in qualitative research

The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS.Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting.Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study

BACKGROUND: Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. METHODS: In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children-or their mothers, in the case of stillbirths and deaths in children younger than 6 months-had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0-27 days), and child deaths (aged 28 days to <5 years). FINDINGS: Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. INTERPRETATION: Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. FUNDING: Bill & Melinda Gates Foundation

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

Predictors of time to first symptomatic recovery of major depressive disordered patients: a case study at Jimma University Medical Center

Abstract Background Major Depressive Disorder is one of the most common mental disorders, and it is the main cause of disability worldwide with a prevalence ranging from 7 to 21%. Objective The goal of this study was to predict the time it took for patients with severe depressive disorders at Jimma University Medical Center to experience their initial symptomatic recovery. Study design The researchers utilized a prospective study design. Methods Patients with major depressive disorder were followed up on at Jimma University Medical Center from September 2018 to August 2020 for this study. The Gamma and Inverse Gaussian frailty distributions were employed with Weibull, Log-logistic, and Log-normal as baseline hazard functions. Akaike Information Criteria were used to choose the best model for describing the data. Results This study comprised 366 patients, with 54.1% of them experiencing their first symptomatic recovery from a severe depressive disorder. The median time from the onset of symptoms to symptomatic recovery was 7 months. In the study area, there was a clustering effect in terms of time to first symptomatic recovery from major depressive disorder. According to the Log-normal Inverse-Gaussian frailty model, marital status, chewing khat, educational status, work status, substance addiction, and other co-variables were significant predictors of major depressive disorder (p-value < 0.05). Conclusion The best model for describing the time to the first symptomatic recovery of major depressive disorder is the log-normal Inverse-Gaussian frailty model. Being educated and working considerably were the variables that reduces the time to first symptomatic recovery from major depressive disorder; whereas being divorced, chewing khat, substance abused and other co-factors were the variables that significantly extends the time to first symptomatic recovery

Knowledge about neonatal danger signs and associated factors among mothers attending immunization clinic at Arba Minch General Hospital, Southern Ethiopia : a cross-sectional study

Background. The first 28 days of life (the neonatal period) constitute the most vulnerable time for a child's survival. Overall 2.7 million neonatal deaths were stated by the 2015 global report of neonatal mortality and they account for 45% of under-five deaths. Sub-Saharan Africa remains the region with the highest risk of death in the first month of life and is among the regions showing the least progress in reducing neonatal mortality in the world. Ethiopia, as part of sub-Saharan Africa, also shares the greatest risk of neonatal death. A recent report in Ethiopia showed that neonatal mortality was 29 deaths per 1,000 live births. Therefore, the signs that suggest the onset of severe illness which leads to death and their contributing factors should be identified. The aim of the study was to assess knowledge about neonatal danger signs and associated factors among mothers attending immunization clinic at Arba Minch General Hospital. Method. Institution-based cross-sectional study design was employed from Feb to April 2018. Systematic sampling technique was used to select a total of 345 mother-child pairs. A pretested, structured, and interviewer-administered questionnaire was used to collect data. Data were entered using Epidata version 3.1 and analyzed using SPSS version 20. Bivariate and multivariable analysis were carried out using binary logistic regression to check and test the association between dependent and explanatory variables. Model fitness was checked by Hosmer-Lemeshow goodness of fit test. Result. Nearly two-fifths (40.9%) of all mothers had good knowledge about neonatal danger signs (95% CI; 35.7, 46.4). Close to thirty-three percent of mothers identified child's body hotness (fever) as a neonatal danger sign. Maternal educational status (AOR: 5.64; 95% CI: 1.68, 18.95) and attendance of postnatal care (AOR: 2.64; 95% CI: 1.36, 5.15) were significantly associated with maternal knowledge about neonatal danger signs in multivariable analysis. Conclusion. Even though considerable improvement has been achieved over the past decades as a result of expanded coverage of maternal and childcare services, still there are a significant number of mothers who have limited knowledge about neonatal danger signs. Therefore, interventional strategies that stress strengthening maternal education and ANC follow-up should be extended