Adolescents' health service utilization pattern and preferences: Consultation for reproductive health problems and mental stress are less likely

No Abstract Available Ethiop.J.Health Dev. Vol.19 (1) 2005: 29-3

Psychosocial problems among students in preparatory school, in Dessie town, north east Ethiopia

Background: The family environment is critical in supporting a healthy adolescent development. With the establishment of preparatory schools, many students of school age move from rural areas to nearby towns leading to changes in their living arrangement and possibly family connectedness. However, whether this phenomenon predisposes adolescents to greater psychosocial problems is not clear.Objective: This study assesses differential vulnerabilities of preparatory school adolescents to psychosocial problems with reference to their living arrangement and parental attachment. Method: A comparative cross-sectional study was conducted on a sample of 667(512 male and 155 female) preparatory school students in Dessie town, north east Ethiopia in 2004 using a pre-tested and structured questionnaire. Qualitative information was also obtained from four focus group discussions. Result: Approximately a quarter of the students included in the study reported feeling of sadness which made them stop performing some regular activities. Six percent of the adolescents also reported having attempted suicide in the 12 months preceding the study. The study revealed that lower family connectedness and having a living arrangement separate from both biological parents (or living with friends, relatives or alone) were associated with increased odds of having a depressive symptom after controlling for observed covariates. Suicide attempts reported in the 12 months preceding the study were linked to having a history of suicide attempt in the family or among friends, female gender and sexual activity but not with family connectedness.Conclusions: The findings indicate that the burden of psychosocial concerns including depressive symptoms, suicidal thoughts and suicide attempts are high and living with both biological parents and good parent-teen connectedness are related to better psychosocial health. The Ethiopian Journal of Health Development Vol. 20(1) 2006: 47-5

Reproductive health needs of out-of-school adolescents: A cross-sectional

Background: It is a globally acknowledged that adolescents, in general, and out-of-school adolescents, in particular often lack access to health information, counseling, legal protection, as well as health care and other social services. Objective: This study is intended to assess and compare reproductive health needs of rural and urban out-of-school adolescents. Methods: A cross-sectional, comparative study was conducted in East Gojjam zone, northwest Ethiopia, in May 2001. Twelve kebeles (smallest social administrative units) were randomly selected from four districts (one urban and three rural). A modified, random walk method was used to identify households in each cluster. Trained 12th grade students collected data using pretested questionnaires. The x2 - test, the t- test, and the Odds Ratio (OR) with 95% Confidence Interval (CI) were used in data analysis. A multiple logistic regression analysis was performed using the SPSS version 10 statistical program to assess the relative impact of variables on sexual activity and contraceptive use. Results: Overall, 1001 adolescents responded to the interview. Knowledge on reproductive issues appeared good but several misconceptions were observed. Only 53% of the study participants knew that a healthy looking person can have HIV while 40% said that a person can get HIV the first time he/ she has sex. About 10% of the participants believed that they were at risk of getting HIV in the next 12 months, whereas more than 45% reported that they had sexual experience. The mean age at first sexual onset was found to be 13.6 years. Significantly higher proportions of rural adolescents were also found to be sexually active (OR =3.0; 95%CI = 1.9, 6.2). About 46% of the sexually active rural adolescents had 2-5 lifetime sexual partners compared to 35.4% of their urban counterparts. However, contraceptive use including condoms was ten times lower among rural adolescents (OR = 0.10; 95%CI =0.04 - 0.3). Only 2% of the rural compared to 35% of the urban sexually active adolescents had ever used condoms. A high divorce rate of 32% in rural and 27% in the urban adolescents was noted.Conclusions: Early and unprotected sexual activity and misconceptions about HIV/AIDS were found to be prevalent in the study population and rural out-of-school adolescents are at the greatest risk of sexual and reproductive health problems. In this era of the rapid spread of HIV/AIDS, high mobility and the ever increasing interaction between rural and urban populations, appropriate programs to prevent HIV/AIDS and promote reproductive health should be designed for out of school adolescents and rural out of school adolescents need the utmost attention.The Ethiopian Journal of Health Development Vol. 20(1) 2006: 10-1

Epidemic prone diseases in Ethiopia EPHA Expert Group report

Infectious agents have caused disease and death in human populations throughout history . Some of the most devastating epidemics ever recorded have been caused by uncontrollable spread of dangerous human pathogens. The plague epidemic of the middle ages was responsible for the death of 13 million people in Europe during a four-year period (1). More recently, in the first part of the century , pandemic influenza swept the world by killing 20 million people in less than a Year's time (1). At present the world population is affected by devastating epidemics that have resulted in high morbidity and mortality

Factors affecting birth preparedness and complication readiness in Jimma Zone, Southwest Ethiopia: a multilevel analysis

Introduction: birth preparedness and complication readiness have been considered as comprehensive strategy aimed at promoting the timely utilization of skilled maternal health care. However, its status and affecting factors have not been well studied at different levels in the study area. Thus, this study was aimed to fill this gap by conducting community based study. Methods: a cross-sectional study was conducted among randomly selected 3612 pregnant women from June-September 2012. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Mixed-effects multilevel logistic regression model was used to identify factors affecting birth preparedness and complication readiness. Results: the status of birth preparedness and complication readiness was 23.3% (95% CI: 21.8%, 24.9%). Being in urban residence and having health center within two hours distance were among the higher level factors increasing birth preparedness and complication readiness. Educational status of primary or above, husband's occupation of employed or merchant, third or above wealth quintiles, knowledge of key danger signs during labor, attitude and frequency of antenatal care visits were among the lower level factors found to increase the likelihood of preparation for birth and its complications. Conclusion: the status of birth preparedness and complication readiness was low in the study area. Both community level and individual level factors had important program implications. Socio demographic, economic, knowledge of key danger signs, attitude and antenatal care use were identified as associated factors. Improving antenatal care, giving special emphasis to danger signs and community based health education are recommended

Vulnerability to episodes of extreme weather: Butajira, Ethiopia, 1998–1999

BACKGROUND: During 1999-2000, great parts of Ethiopia experienced a period of famine which was recognised internationally. The aim of this paper is to characterise the epidemiology of mortality of the period, making use of individual, longitudinal population-based data from the Butajira demographic surveillance site and rainfall data from a local site. METHODS: Vital statistics and household data were routinely collected in a cluster sample of 10 sub-communities in the Butajira district in central Ethiopia. These were supplemented by rainfall and agricultural data from the national reporting systems. RESULTS: Rainfall was high in 1998 and well below average in 1999 and 2000. In 1998, heavy rains continued from April into October, in 1999 the small rains failed and the big rains lasted into the harvesting period. For the years 1998-1999, the mortality rate was 24.5 per 1,000 person-years, compared with 10.2 in the remainder of the period 1997-2001. Mortality peaks reflect epidemics of malaria and diarrhoeal disease. During these peaks, mortality was significantly higher among the poorer. CONCLUSIONS: The analyses reveal a serious humanitarian crisis with the Butajira population during 1998-1999, which met the CDC guideline crisis definition of more than one death per 10,000 per day. No substantial humanitarian relief efforts were triggered, though from the results it seems likely that the poorest in the farming communities are as vulnerable as the pastoralists in the North and East of Ethiopia. Food insecurity and reliance on subsistence agriculture continue to be major issues in this and similar rural communities. Epidemics of traditional infectious diseases can still be devastating, given opportunities in nutritionally challenged populations with little access to health care

Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa

Objective To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Design Diagnostic accuracy study. Setting Ethiopia, India and South Africa. METHODS: Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. RESULTS: Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. CONCLUSION: The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability

Malaria-related mortality based on verbal autopsy in an area of low endemicity in a predominantly rural population in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Although malaria is one of the most important causes of death in Ethiopia, measuring the magnitude of malaria-attributed deaths at community level poses a considerable difficulty. Nevertheless, despite its low sensitivity and specificity, verbal autopsy (VA) has been the most important technique to determine malaria-specific cause of death for community-based studies. The present study was undertaken to assess the magnitude of malaria mortality in a predominantly rural population of Ethiopia using VA technique at Butajira Rural Health Programme (BRHP) Demographic Surveillance Site (DSS).</p> <p>Methods</p> <p>A verbal autopsy was carried out for a year from August 2003 to July 2004 for all deaths identified at BRPH-DSS. Two trained physicians independently reviewed each VA questionnaire and indicated the most likely causes of death. Finally, all malaria related deaths were identified and used for analysis.</p> <p>Results</p> <p>A verbal autopsy study was successfully conducted in 325 deaths, of which 42 (13%) were attributed to malaria. The majority of malaria deaths (47.6%) were from the rural lowlands compared to those that occurred in the rural highlands (31%) and urban (21.4%) areas. The proportional mortality attributable to malaria was not statistically significant among the specific age groups and ecological zones. Mortality from malaria was reckoned to be seasonal; 57% occurred during a three-month period at the end of the rainy season between September and November. About 71% of the deceased received some form of treatment before death, while 12 (28.6%) of those who died neither sought care from a traditional healer nor were taken to a conventional health facility before death. Of those who sought treatment, 53.3% were first taken to a private clinic, 40% sought care from public health facilities, and the remaining two (6.7%) received traditional medicine. Only 11.9% of the total malaria-related deaths received some sort of treatment within 24h after the onset of illness.</p> <p>Conclusion</p> <p>The results of this study suggest that malaria plays a considerable role as a cause of death in the study area. Further data on malaria mortality with a relatively large sample size for at least two years will be needed to substantially describe the burden of malaria mortality in the study area.</p