The pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestation in Ethiopia: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Even though the prevalence of HIV infection among the adult population in Ethiopia was estimated to be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective study was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations.</p> <p>Methods</p> <p>Medical records of 347 patients (age ≥13 years) admitted to Tikur Anbesa Hospital from September 2002 to August 2009 were reviewed and demographic and clinical data were collected.</p> <p>Results</p> <p>Data from 347 patients were analysed. The mean age was 34.6 years. The diagnosis of HIV was made before current admission in 33.7% and 15.6% were on antiretroviral therapy (ART). Causes of neurological manifestation were: cerebral toxoplasmosis (36.6%), tuberculous meningitis (22.5%), cryptococcal meningitis (22.2%) and bacterial meningitis (6.9%). HIV-encephalopathy, primary central nervous system (CNS) lymphoma and progressive multifocal leukoencephalopathy were rare in our patients. CD4 count was done in 64.6% and 89.7% had count below 200/mm3[mean = 95.8, median = 57] and 95.7% were stage IV. Neuroimaging was done in 38% and 56.8% had mass lesion. The overall mortality was 45% and the case-fatality rates were: tuberculous meningitis (53.8%), cryptococcal meningitis (48.1%), cerebral toxoplasmosiss (44.1%) and bacterial meningitis (33.3%). Change in sensorium and seizure were predictors of mortality.</p> <p>Conclusions</p> <p>CNS opportunistic infections were the major causes of neurological manifestations of HIV/AIDS and were associated with high mortality and morbidity. Almost all patients had advanced HIV disease at presentation. Early diagnosis of HIV, prophylaxis and treatment of opportunistic infections, timely ART, and improving laboratory services are recommended. Mortality was related to change in sensorium and seizure.</p

Why do women prefer home births in Ethiopia?

Background: Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. Methods: The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions. Results: Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization. Conclusions: The study indicated the crucial role of proper health care provider-client communication and providing a more client centered and culturally sensitive care if utilization of existing health facilities is to be maximized. Implications of findings for maternal health programs and further research are discussed

National Ag-Data Hub project technical report - phase one

This document is a technical progress report of a work aimed to develop a national ag data hub in Ethiopia. The document is not a full technical implementation report of the national ag data hub. It is the technical report of the first phase as per the agreement entered between CIAT and ACATECH TECHNOLOGY PLC to implement the system in a phase by phase approach. This report has two main parts. The first part provides background information about the project which includes a brief introduction about the first phase deliverables. This shows the scope of the project to be completed in the first phase (i.e. in the last three months). The second part describes the project activities and progress in contrast to the plan set at the beginning. This part clearly showed the progress achieved so far

Associations of weight and body composition at birth with body composition and cardiometabolic markers in children aged 10 y: the Ethiopian infant anthropometry and body composition birth cohort study

Background: Although birth weight (BW) has been associated with later cardiovascular disease and type 2 diabetes, the role of birth fat mass (BFM) and birth fat-free mass (BFFM) on cardiometabolic health is unclear. // Objectives: To examine associations of BW, BFM, and BFFM with later anthropometry, body composition, abdominal fat, and cardiometabolic markers. // Methods: Birth cohort data on standardized exposure variables (BW, BFM, and BFFM) and follow-up information at age 10 y on anthropometry, body composition, abdominal fat, and cardiometabolic markers were included. A linear regression analysis was used to assess associations of exposures with outcome variables, adjusting for maternal and child characteristics at birth and current body size in separate models. // Results: Among 353 children, mean (SD) age was 9.8 (1.0) y, and 51.5% were boys. In the fully adjusted model, 1-SD higher BW and BFFM were associated with 0.81 cm (95% CI: 0.21, 1.41 cm) and 1.25 cm (95% CI: 0.64, 1.85 cm) greater height at 10 y, respectively. The 1-SD higher BW and BFM were associated with 0.32 kg/m2 (95% CI: 0.14, 0.51 kg/m2) and 0.42 kg/m2 (95% CI: 0.25, 0.59 kg/m2) greater fat mass index at 10 y, respectively. In addition, 1-SD higher BW and BFFM were associated with 0.22 kg/m2 (95% CI: 0.09, 0.34 kg/m2) greater FFM index, whereas a 1-SD greater BFM was associated with a 0.05 cm greater subcutaneous adipose tissue (95% CI: 0.01, 0.11 cm). Furthermore, 1-SD higher BW and BFFM were associated with 10.3% (95% CI: 1.4%, 20.0%) and 8.3% (95% CI: −0.5%, 17.9%) greater insulin, respectively. Similarly, 1-SD higher BW and BFFM were associated with 10.0% (95% CI: 0.9%, 20.0%) and 8.5% (95% CI: −0.6%, 18.5%) greater homeostasis model assessment of insulin resistance, respectively. // Conclusions: BW and BFFM rather than BFM are predictors of height and FFM index at 10 y. Children with higher BW and BFFM showed higher insulin concentrations and homeostasis model assessment of insulin resistance at 10 y of age. // This trial was registered at ISRCTN as ISRCTN46718296

Associations of weight and body composition at birth with body composition and cardiometabolic markers in children aged 10 y: the Ethiopian infant anthropometry and body composition birth cohort study.

BACKGROUND: Although birth weight (BW) has been associated with later cardiovascular disease and type 2 diabetes, the role of birth fat mass (BFM) and birth fat-free mass (BFFM) on cardiometabolic health is unclear. OBJECTIVES: To examine associations of BW, BFM, and BFFM with later anthropometry, body composition, abdominal fat, and cardiometabolic markers. METHODS: Birth cohort data on standardized exposure variables (BW, BFM, and BFFM) and follow-up information at age 10 y on anthropometry, body composition, abdominal fat, and cardiometabolic markers were included. A linear regression analysis was used to assess associations of exposures with outcome variables, adjusting for maternal and child characteristics at birth and current body size in separate models. RESULTS: Among 353 children, mean (SD) age was 9.8 (1.0) y, and 51.5% were boys. In the fully adjusted model, 1-SD higher BW and BFFM were associated with 0.81 cm (95% CI: 0.21, 1.41 cm) and 1.25 cm (95% CI: 0.64, 1.85 cm) greater height at 10 y, respectively. The 1-SD higher BW and BFM were associated with 0.32 kg/m2 (95% CI: 0.14, 0.51 kg/m2) and 0.42 kg/m2 (95% CI: 0.25, 0.59 kg/m2) greater fat mass index at 10 y, respectively. In addition, 1-SD higher BW and BFFM were associated with 0.22 kg/m2 (95% CI: 0.09, 0.34 kg/m2) greater FFM index, whereas a 1-SD greater BFM was associated with a 0.05 cm greater subcutaneous adipose tissue (95% CI: 0.01, 0.11 cm). Furthermore, 1-SD higher BW and BFFM were associated with 10.3% (95% CI: 1.4%, 20.0%) and 8.3% (95% CI: -0.5%, 17.9%) greater insulin, respectively. Similarly, 1-SD higher BW and BFFM were associated with 10.0% (95% CI: 0.9%, 20.0%) and 8.5% (95% CI: -0.6%, 18.5%) greater homeostasis model assessment of insulin resistance, respectively. CONCLUSIONS: BW and BFFM rather than BFM are predictors of height and FFM index at 10 y. Children with higher BW and BFFM showed higher insulin concentrations and homeostasis model assessment of insulin resistance at 10 y of age. This trial was registered at ISRCTN as ISRCTN46718296

Contraceptive Use among Women Seeking Repeat Abortion in Addis Ababa, Ethiopia

Limited access to modern contraceptives in populations that desire smaller families can lead to repeat unintended pregnancy and repeat abortions. We conducted an analysis of the medical records of 1,200 women seeking abortion-related services in public and private facilities in Addis Ababa, Ethiopia from October 2008 to February 2009. We examined the characteristics of initial and repeat abortion clients including prior contraceptive use and subsequent method selection. The incidence of repeat abortion was 30%. Compared with women seeking their first abortion, significantly more repeat abortion clients had ever used contraceptives and they were nearly twice as likely to leave the facility with a method. However, repeat abortion clients were significantly more likely to have ever used short-term reversible methods and to choose short-term methods post-abortion. Contraceptive counseling services for repeat abortion clients’ should address reasons for previous contraceptive failure, discontinuation, or non-use. Post-abortion family planning services should be strengthened to help decrease repeat abortion. Keywords: abortion, repeat abortion, contraception, urban, Ethiopia (Afr J Reprod Health 2013; 17[4]: 56-65

Factors Associated with Choice of Post-Abortion Contraception in Addis Ababa, Ethiopia

The high demand for abortion related services in Addis Ababa, Ethiopia indicates a reliance on abortion to control fertility and highlights an opportunity to increase access to contraceptives and improve post-abortion care. We analyzed the medical records of 1,200 women seeking abortion related services. Logistic regression was used to determine factors associated with use of modern or long-acting contraceptive post-abortion. Multivariate results illustrate that women aged 40-44, students, employed women, receipt of services in private clinics, number of children, and number of previous abortions were significantly associated with the odds of adopting any modern contraceptive post-abortion. The odds of choosing a long-active contraceptive method were significantly and positively associated with being age 25-29, attaining secondary or higher education, and number of children. Improved services and information along with reliable access to modern and long-acting contraceptives can reduce the need to use abortion to control fertility among women in Addis. (Afr J Reprod Health 2011; 15[3]: 55-62).La demande augment ée des services relatifs à l&apos;avortement à Addis Abéba, Ethiopie, montre une indépendance de l&apos;avortement pour contrôler la fertilité et souligne une opportunité pour augmenter l&apos;accès aux contraceptifs et améliorer les soins du post-avortement. Nous avons analysé les dossiers des 1200 femmes qui recherchaient des services liés à l&apos;avortement. Nous nous sommes servis de la régression logistique pour déterminer les facteurs liés à l&apos;utilisation du contraceptif du post-avortement modern ou à action prolongée. Des résultats ont montré que les femmes âgées de 40-44 ans, les étudiantes, les femmes employées, fréquentation des cliniques privées pour les services, nombre d&apos;enfants et nombre d&apos;avortements antérieurs, ont été significativement liés à la possibilité d&apos;adopter n&apos;importe quel contraceptif du post-abortion modern. La possibilité de choisir une méthode contraceptive à action prolongée a été considérablement et positivement liée au fait d&apos;avoir 25-29 ans, ayant acquis l&apos;éducation du niveau secondaire ou tertiaire et le nombre d&apos;enfants. L&apos;on peut réduire le besoin de contrôler la fertilité chez les femmes à Addis si les services et l&apos;information ainsi que l&apos;accès fiable aux contraceptifs modernes et à action prolongée sont améliorés

Population structure and phenological attributes of Adansonia digitata L. (baobab) in Northwestern lowland area of Ethiopia

Adansonia digitata (baobab), a multipurpose and highly valued tree species, is facing threats due to anthropogenic factors like shifting cultivation practices and fire. The aim of this study was to examine the population structure and phenological attributes of baobab in three districts (i.e. Kafta Humera, Tselemt, and Quara district) in Northwestern Ethiopia. The study was carried out by establishing 17 plots 1 km long and 100 m wide covering a total area of 170 ha in the Quara district and five plots covering 50 ha each in the Kafta Humera and Tselemt districts. Further, plots were subdivided into 25 × 25 m and 5 × 5 m sub-plots for recording other woody species and their regeneration status, respectively. Thirty reproductively matured trees with easily visible crowns were selected to record phenological characteristics and fruit yield. The findings revealed that baobab population was significantly higher in the Tselemt district (3.15 ± 0.15) as compared to Quara (1.43 ± 0.43) and Kafta Humera (1.30 ± 0.23) sites. A bell-shaped diameter distribution was observed in the Quara district and irregular-shaped distributions were observed in Kafta Humera and Tselemt districts. Phenological periodicity and fruit production of baobab did not vary significantly among the three study sites. On average, 404 fruits per tree were recorded with a maximum of 559 fruits in mid-diameter size class trees. Due to livestock browsing, shifting cultivation practices, and uncontrolled fire, the recruitments are limited in the study areas. An in-situ conservation strategy through the plantation and proper management practices are needed to sustain baobab tree species

Fertility awareness and post-abortion pregnancy intention in Addis Ababa, Ethiopia

Background: Abortion related complications are known to be among the leading causes of maternal mortality and disabilities in developing countries. Objectives: The aim of the study was to assess the knowledge of post-abortion patients, regarding return of fertility and pregnancy intentions. Methods: Cross sectional study was undertaken in four government hospitals in Addis Ababa, Ethiopia from November 2001 to February 2002. Four hundred post-abortion cases were interviewed at the point of their discharge to get information on their fertility awareness and future pregnancy intentions. Results: Seventeen percent of the respondents who reported that the pregnancies were unwanted admitted some kind of interference with the pregnancy. Thirty six percent reported that they were assisted at clinics for inducing the abortion. Overall about 82% of them reported not having a plan to become pregnant in three months period following the abortion. Seventy three percent of them were not able to tell the time at which they could become pregnant if involved in sexual intercourse after the present abortion. Conclusion: This study revealed the urgent demand for quality services that should include education and provision of family planning counseling and methods. Ethiop.J.Health Dev. 2003;17(3):167-17