Neglected Tropical Diseases (NTD) service availability at health facilities in Ethiopia: Evidence from 2014 Ethiopian service provision assessment

Background: Neglected tropical diseases (NTDs) are a group of infections which are especially endemic in low-income populations in developing regions of Africa, Asia, and the Americas. In sub-Saharan Africa, the impact of these diseases as a group is comparable to malaria and tuberculosis. The diseases recognized as neglected tropical diseases by the World Health Organization (WHO) are: Chagas disease, Cysticercosis and taeniasis, Dengue fever, Dracunculiasis, Echinococcosis, Human African trypanosomiasis, Leishmaniasis, Leprosy, Lymphatic filariasis, Onchocerciasis, Rabies, Schistosomiasis, Soil-transmitted helminthiasis, Trachoma, and Yaws. Most of these diseases are either preventable through mass drug administration (MDA) and proper hygiene and sanitation, or treatable through systematic case finding and management. This study was conducted with the aim of assessing the availability of services for neglected tropical diseases management at health facilities in Ethiopia.Method: The assessment is part of the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) Survey. A total of 873 health facilities were assessed for this analysis. All Hospitals, selected health centre, and private clinics were assessed if they provide services for Neglected Tropical Diseases.Result: More than half of all health facilities offer services for both soil transmitted helminthes (64 percent), and services for trachoma (60 percent). About four of every ten health facilities offer services for schistosomiasis. On the other hand, services for onchocerciasis, leishmanianis and lymphatic filariases were available in less than a third of all health facilities (27%, 25% and 24%, respectively).Conclusion and recommendation: Even though, the availability of service for neglected tropical disease in health facilities is relatively good in general, there should be equitable distribution of neglected tropical disease service provision among regions. And private facilities should give emphasis for the provision of these services. Key words: Service Availability, NTDs, SPA+, Ethiopia

Determinants of full valid vaccine dose administration among 12-32 months children in Ethiopia: Evidence from the Ethiopian 2012 national immunization coverage survey

Introduction: According to the 2012 national immunization coverage survey report of Ethiopia, EPI coverage by antigen is 79.6% for BCG, 80.0% for DPT-HepB-Hib1 90.1% for OPV1 65.7%; for adjusted DPT-HepB-Hib 3; 65.7 % for OPV3 and 68.2% for Measles. Similarly, the prevalence of full vaccination was 50%. However, the prevalence of valid vaccination dose for all vaccines is 18.6 %. Therefore, the aim of this study is to identify factors that determine the administration of full valid vaccines dose to set effective interventions.Methods: Data was obtained from the 2012 Immunization Coverage survey of Ethiopia, a cross- sectional study administered at the household level. Data were analyzed using SPSS version 20. Binary and multivariate logistic regression with 95% CI was done to assess factors associated with getting full valid vaccination dose. Results: As documented from the 2012 national immunization coverage survey, the coverage of full valid vaccination dose were very low as compared to full immunization coverage that is 18.6% Vs 50%, respectively. Urban residence 2.6 (95% CI: 2.50, 2.68), mothers with age groups of 21-34 and >35 were 1.26 (95% CI: 1.22, 1.29) and 2.4 (95% CI: 2.3, 2.44); children with caretakers with primary, secondary, and higher level of education were 1.6 (95% CI: 1.22, 1.29), 2.8 (95% CI: 2.76, 2.92), and 2.2 (95% CI: 2.13, 2.27) times more likely to get valid vaccination dose.Conclusion: The rich wealth quintile, rural place of residence, living more than 5km proximity to nearest health facility, having more than six sibling, having teenage (<20years old) mother, having mother with no formal education, having mother/ care giver with no card or family folder which state children vaccination status sources, and having mother who did not heard a message about importance of vaccine were found to be the independent determinants of low valid dose immunization. The efforts at all level to increase full valid vaccination coverage by targeting activities to socio-economic, socio-demographic, organizational, and related determinants. [Ethiop. J. Health Dev. 2016;30(3):135-141]Keywords: Valid dose, vaccination, Ethiopi

Tuberculosis Service Provision in Ethiopia: Health Facility Assessment

The major objective of the survey is to assess the availability and preparedness of health facilities in Ethiopia to provide quality Tuberculosis services. The survey was part of the 2014 Ethiopia Service Provision Assessment Plus Survey. A total of 1,327 health facilities were assessed. The results shows that more than two out of three (69%) facilities excluding health posts in Ethiopia offer any TB diagnostic, treatment or/and treatment follow up services. Among all health posts, 29% of them offer any TB diagnostic services and any treatment and/or treatment follow up services. Six in ten (59%) of facilities excluding health posts use sputum smear only to diagnose TB. Of those facilities offering any TB services more than half (60%) have trained staff. Among facilities excluding health posts offering any TB services, 44% have guidelines for diagnosis and treatment of TB, 18% have guideline for diagnosis and treatment of MDR-TB, and 9% have guideline for management of HIV and TB co-infection.As a conclusion we can say that any TB diagnostic, treatment or/and treatment follow up services is available in more than half of the facilities in Ethiopia excluding health post. Half of the health facilities in Ethiopia excluding health post have guidelines for diagnosis and treatment of TB

Pattern and Trend of Medical Admissions of Patients of Chronic Non-Communicable Diseases in Selected Hospitals in Addis Ababa, Ethiopia

Although chronic non-communicable diseases (NCDs) have been of major importance in developed countries for several decades, currently it is becoming recognized as a major public health threats in the developing world too.The increasing NCDs burden is compounded by failure in provision of clear and up-to-date evidence on the burden for key decision makers. The present study is designed to collect retrospective secondary data from selected Government and Private Hospitals in Addis Ababa that offer services to out-patients of NCDs through special referral clinics. The Objective of this research is to depict the patterns and trends of common NCDs in Government and Private Hospitals in Adds Ababa, and provide decision makers with  information on the burden of NCDs at  health facility level.In order to collect retrospective data, four Governments and five Private owned Hospitals in Addis Ababa that offer referral clinic for NCD were selected. Data of NCD out-patients from 2007 to 2011 were considered for present study. Records of cardiovascular diseases, diabetes mellitus, cancer, chronic kidney diseases and chronic pulmonary obstructive diseases including asthma were collected. The data were collected from Hospital registration and patient records anonymously by respective Hospital staff members assigned in the referral clinics.Records of 46,565 patients were collected and more than 60% data were obtained from TikurAnbessa Specialized Teaching Hospital and International cardiac center. Majority of the clients (77 %) were from urban areas while 23% from rural areas. With regard to gender, 56% of the patients are females and 44% males.  As age increases the proportion of patients with NCDs increased and there was a decline after 54 years. Among the patients who were attending outpatient clinics, the vast majority about 40% were patients were with cardiovascular diseases while diabetes and cancer each independently accounts 20% of the proportion. Patients with chronic pulmonary obstructive diseases including asthma, and chronic kidney diseases were 6% and 5%, respectively. Information regarding the status of patients while making follow-up was also collected. It resulted in about 56% of all NCDs out-patients were actively following their health condition by making   frequent visit to their respective out-patient referral clinics, about 2% were deceased and 1% referred to other hospitals, about 41.2% of all NCDs patients were found to be drop-out for unknown reasons. This research reveals that NCDs are becoming public health problems in Addis Ababa. Therefore, there is a need for population-based representative survey to quantify the burden with risk factors for policy formulation and interventions against this emerging epidemic. Moreover, further study is recommended to investigate the reasons of patients why they discontinue care & treatment offered at facility level

Individual and culture-level components of survey response styles: a multi-level analysis using cultural models of selfhood

Variations in acquiescence and extremity pose substantial threats to the validity of cross-cultural research that relies on survey methods. Individual and cultural correlates of response styles when using two contrasting types of response mode were investigated, drawing on data from 55 cultural groups across 33 nations. Using seven dimensions of self-other relatedness that have often been confounded within the broader distinction between independence and interdependence, our analysis yields more specific understandings of both individual- and culture-level variations in response style. When using a Likert scale response format, acquiescence is strongest among individuals seeing themselves as similar to others, and where cultural models of selfhood favour harmony, similarity with others and receptiveness to influence. However, when using Schwartz’s (2007) portrait-comparison response procedure, acquiescence is strongest among individuals seeing themselves as self-reliant but also connected to others, and where cultural models of selfhood favour self-reliance and self-consistency. Extreme responding varies less between the two types of response modes, and is most prevalent among individuals seeing themselves as self-reliant, and in cultures favouring self-reliance. Since both types of response mode elicit distinctive styles of response, it remains important to estimate and control for style effects to ensure valid comparisons

Being oneself through time: bases of self-continuity across 55 cultures

Self-continuity – the sense that one’s past, present, and future are meaningfully connected – is considered a defining feature of personal identity. However, bases of self-continuity may depend on cultural beliefs about personhood. In multilevel analyses of data from 7287 adults from 55 cultural groups in 33 nations, we tested a new tripartite theoretical model of bases of self-continuity. As expected, perceptions of stability, sense of narrative, and associative links to one’s past each contributed to predicting the extent to which people derived a sense of self-continuity from different aspects of their identities. Ways of constructing self-continuity were moderated by cultural and individual differences in mutable (vs. immutable) personhood beliefs – the belief that human attributes are malleable. Individuals with lower mutability beliefs based self-continuity more on stability; members of cultures where mutability beliefs were higher based self-continuity more on narrative. Bases of self-continuity were also moderated by cultural variation in contextualized (vs. decontextualized) personhood beliefs, indicating a link to cultural individualism-collectivism. Our results illustrate the cultural flexibility of the motive for self-continuity

Beyond the ‘East-West’ dichotomy: global variation in cultural models of selfhood

Markus and Kitayama’s (1991) theory of independent and interdependent self-construals had a major influence on social, personality, and developmental psychology by highlighting the role of culture in psychological processes. However, research has relied excessively on contrasts between North American and East Asian samples, and commonly used self-report measures of independence and interdependence frequently fail to show predicted cultural differences. We revisited the conceptualization and measurement of independent and interdependent self-construals in 2 large-scale multinational surveys, using improved methods for cross-cultural research. We developed (Study 1: N = 2924 students in 16 nations) and validated across cultures (Study 2: N = 7279 adults from 55 cultural groups in 33 nations) a new 7-dimensional model of self-reported ways of being independent or interdependent. Patterns of global variation support some of Markus and Kitayama’s predictions, but a simple contrast between independence and interdependence does not adequately capture the diverse models of selfhood that prevail in different world regions. Cultural groups emphasize different ways of being both independent and interdependent, depending on individualism-collectivism, national socioeconomic development, and religious heritage. Our 7-dimensional model will allow future researchers to test more accurately the implications of cultural models of selfhood for psychological processes in diverse ecocultural contexts

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

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

Reliability and validity of an interviewer-administered adaptation of the Youth Self-Report for mental health screening of vulnerable young people in Ethiopia

Objective: Evaluate the reliability and validity of the Youth Self-Report (YSR) as a screening tool for mental health problems among young people vulnerable to HIV in Ethiopia. Design: A cross-sectional assessment of young people currently receiving social services. Methods: Young people age 15–18 participated in a study where a translated and adapted version of the YSR was administered by trained nurses, followed by an assessment by Ethiopian psychiatrists. Internal reliability of YSR syndrome scales were assessed using Chronbach\u27s alpha. Test-retest reliability was assessed through repeating the YSR one month later. To assess validity, analysis of the sensitivity and specificity of the YSR compared to the psychiatrist assessment was conducted. Results: Across the eight syndrome scales, the YSR best measured the diagnosis of anxiety/depression and social problems among young women, and attention problems among young men. Among individual YSR syndrome scales, internal reliability ranged from unacceptable (Chronback’s alpha = 0.11, rule-breaking behavior among young women) to good (α ≥ 0.71, anxiety/depression among young women). Anxiety/depression scores of ≥ 8.5 among young women also had good sensitivity (0.833) and specificity (0.754) to predict a true diagnosis. The YSR syndrome scales for social problems among young women and attention problems among young men also had fair consistency and validity measurements. Most YSR scores had significant positive correlations between baseline and post-one month administration. Measures of reliability and validity for most other YSR syndrome scales were fair to poor. Conclusions: The adapted, personally administered, Amharic version of the YSR has sufficient reliability and validity in identifying young vulnerable women with anxiety/depression and/or social problems, and young men with attention problems; which were the most common mental health disorders observed by psychiatrists among the migrant populations in this study. Further assessment of the applicability of the YSR among vulnerable young people for less common disorders in Ethiopia is needed