Strategies to revitalize immunization service provision in urban settings of Ethiopia

AbstractBackground: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopi

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

The self-concept and socio-emotional development of deaf and hard-of-hearing students in different educational settings and their hearing peers in Ethiopia

This thesis examined the socio-emotional problems and self-concept of deaf and hard of hearing (DHH) students in different educational settings (special class/ unit, special school) compared to those of hearing students in Ethiopia. Furthermore, the study investigated the transition of DHH students from 4th grade (cycle 1) into 5th grade (cycle 2) in relation to the academic achievement, academic self-concept and their social wellbeing. In this transition DHH students from special class/ unit transited into mainstream education. A total of 103 students selected from seven towns in Ethiopia, representing three groups in different school settings participated in the first study when they were in Grade 4 (Time 1). The second measurement was made after a year on 72 participants who transitioned to Grade 5 (Time 2). The aims of the study were addressed in three sub studies. Data was collected using the self-report version of Strengths and Difficulties Questionnaire (Goodman, 1997) to measure the socio-emotional aspects and the Self-Description Questionnaire (SDQ-I, Marsh, 1990) to measure the multidimensional aspects of children’s self-concept. The results showed that, compared to the hearing sample, the DHH students experienced more severe socioemotional problems across all dimensions. In comparison to their hearing peers, DHH students (regardless of their educational setting) had a lower self-concept in the areas of general self, general school, reading, and parental relations. The DHH students in the special school showed a higher self-concept in regard to their physical appearance than the hearing and DHH students in the special class. There were no statistically significant differences between the groups in the self-concept dimensions of peer relations, mathematics, and physical abilities. The academic achievement and academic self-concept of DHH students decreased when they transferred to the mainstream setting, while the academic achievement and selfconcept of the DHH students continuing in a special school remained stable. All three groups showed improvements in their social self-concept after the transition. The results show that DHH children expressed great concern about their socioemotional difficulties, academic achievement and self-concept. Teachers and other professionals need to know more about the DHH children’s socio-emotional development to help better these children overcome their challenges.Tässä väitöskirjassa tutkittiin etiopialaisten kuurojen ja huonokuuloisten oppilaiden sosio-emotionnaalisia ongelmia ja minäkäsitystä eri koulumuodoissa (erityiskouluissa ja erityisluokilla) ja vertailuryhmänä oli kuulevia oppilaita. Lisäksi tutkittiin kuurojen ja huonokuuloisten oppilaiden akateemisia saavutuksia, minäkuvaa ja sosiaalista hyvinvointia heidän siirtyessään neljänneltä luokalta viidennelle luokalle. Tässä siirtymävaiheessa erityisluokilla olleet kuurot ja huonokuuloiset siirtyivät yleisopetukseen. Tutkimukseen osallistui 103 oppilasta, jotka oli valittu seitsemästä etiopialaisesta kaupungista. Heidät oli valittu kuurojen kouluista, kuurojen erityisluokilta ja kuulevien kouluista. Ensimmäisessä mittauksessa (Time 1) oppilaat olivat neljännellä luokalla. Vuoden kuluttua, toisella mittauskerralla, mukana oli 72 viidennelle luokalle siirtynyttä oppilasta (Time 2). Tutkimus oli kolmeosainen. Oppilaat arvioivat sosio-emotionaalisia vahvuuksiaan ja vaikeuksiaan ”Strength and Difficulties Questionnaire” (Goodman, 1997) mittarilla. Oppilaiden minäkäsityksen mittaamiseen käytettiin Self-Descriptiion Questionnarie-I (Marsh, 1990) mittaria. Tulokset osoittivat, että kuuroilla ja huonokuuloisilla oli vakavampia sosio-emotionaalisia vaikeuksia kuin kuulevilla oppilailla.Verrattuna kuuleviin oppilaisiin kuuroilla ja huonokuuloisilla oppilailla (riippumatta kummassa koulumuodossa he opiskelivat) oli myös heikompi minäkäsitys ja heikompi menestys koulussa. He olivat heikompia erityisesti lukemisessa ja heillä oli huonompi suhde vanhempiinsa. Erityiskouluissa olevilla kuuroilla ja huonokuuloisilla oli parempi itsetunto fyysisestä ulkonäöstään kuin kuulevilla tai erityisluokilla olevilla kuuroilla ja huonokuuloisilla. Ystävyyssuhteissa, matematiikassa ja fyysisissä kyvyissä ei ollut tilastollisesti merkitsevää eroa ryhmien kesken. Erityisluokilla olevien kuurojen ja huonokuuloisten koulumenestys ja akateeminen minäkuva laski, kun he siirtyivät yleisopetukseen viidennelle luokalle. Erityiskouluissa olevien kuurojen ja huonokuuloisten oppilaiden akateemisiin saavutuksiin ja minäkuvaan ei tullut muutoksia heidän siirtyessään viidennelle luokalle. Sosiaalinen minäkäsitys kehittyi positiivisesti kaikilla kolmella ryhmällä siirtymän myötä. Tulokset osoittivat, että etiopialaisten kuurojen ja huonokuuloisten oppilaiden tilanne (sosio-emotionaaliset vaikeudet, koulumenestys ja minäkuva) on hyvin huolestuttava. Opettajien ja muiden alan ammattilaisten on tärkeää tietää kuurojen ja huonokuuloisten oppilaiden tilanne pystyäkseen paremmin auttamaan heitä ja vastaamaan esille tuleviin haasteisiin

Socio-emotional Problems Experienced by Deaf and Hard of Hearing Students in Ethiopia

This study compares the socio-emotional problems experienced by deaf and hard of hearing (DHH) students with those of hearing students in Ethiopia. The research involved a sample of 103 grade 4 students attending a special school for the deaf, a special class for the deaf and a regular school. Socio-emotional problems were measured using Goodman's self-report measure, the Strengths and Difficulties Questionnaire for children and adolescents. Participants were selected from seven towns in Ethiopia. The results show that, compared to the hearing sample, the DHH students experienced more severe socio-emotional problems across all dimensions, regardless of whether they were in special classes or special schools. The DHH children reported that socio-emotional difficulties interfered with their home lives, friendships, classroom learning, and ability to get along with the people around them. The DHH students scored higher in the externalising behavioural domains than did the hearing students. There was no statistically significant difference between the DHH students in the special school and special class settings. The results show that DHH children expressed great concern about their socio-emotional difficulties. Teachers and other professionals need to raise their awareness about DHH issues in order to help these children overcome their challenges.peerReviewe

The Self-Concept of Deaf/Hard-of-Hearing and Hearing Students

The present study investigated the self-concept of deaf and hard-of-hearing (DHH) students in different educational settings compared with those of hearing students in Ethiopia. The research involved a sample of 103 Grade 4 students selected from 7 towns in Ethiopia. They were selected from a special school for the deaf, a special class for the deaf, and a regular school. The Self-Description Questionnaire I ( Marsh, 1990 ) was used to measure the children’s self-concept. The study results indicated that, in comparison with their hearing peers, DHH students had a lower self-concept in the areas of general self, general school, reading, and parental relations. The DHH students in the special school showed a higher self-concept in regard to their physical appearance than the hearing and DHH students in the special class. There were no statistically significant differences between the groups in the self-concept dimensions of peer relations, mathematics, and physical abilities.peerReviewe

Caregivers’ knowledge and attitudes about childhood diarrhea among refugee and host communities in Gambella Region, Ethiopia

Abstract Background Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities. Objective This study aims at assessing the caregivers’ knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia. Methodology This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p < 0.05). Result The study indicates that 633 (28.0%) of the caregivers had poor knowledge, while 393 (23.6%) of them had unfavorable attitudes towards childhood diarrhea. Knowledge of the caregivers was significantly associated with formal education (AOR, 1.3; 95% CI, 1.03–1.5) and health information obtained from a health care institution (AOR, 1.8; 95% CI, 1.28–2.3). Caregivers’ knowledge is a single predictor of their attitude (p < 0.001), and Pearson’s correlation coefficient revealed that there was a significant positive correlation (r = 0.2, p < 0.001) between knowledge and attitude scores. Conclusion The study indicates that significant numbers of caregivers had inadequate knowledge and unfavorable attitudes about diarrhea in under-five children. Designing and implementing an inclusive health education intervention focusing on uneducated child caregivers may be beneficial for improving knowledge and attitudes towards reducing the incidence of acute childhood diarrhea in the region