Clinical characteristics of orbital tumours as seen in a tertiary eye center

Abstract: Clinical files of 93 patients with orbital tumours were examined. Primary orbital tumours accounted for 55% of cases and secondary tumours for 45%. The most frequently diagnosed primary orbital tumours were mucoceles (15%), lacrimal gland tumours (7.5%), and rhabdomyosarcoma (6.5%). The most common secondary orbital tumours were retinoblastoma (23.6%), and squamous cell carcinoma (10%). Commonly found physical signs, radiographic and ultrasonographic findings are reported. Most frequently employed surgical techniques for removal of the tumours was exenteration (64%). Orbitotomy through various approaches was employed in 36% of the patients. Agreement was obtained between the clinical and histopathologic diagnoses for the commonly encountered orbital tumours. Poor outcome is expected, because of late presentation in most patients. Discussion and recommendations on further management of cases is given. [Ethiop. J. Health Dev. 1997;11(3):201-206

Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region, north Ethiopia

Background: Ethiopia is the second most populous country in Sub-Saharan Africa. Total Fertility Rate of Ethiopia is 5.4 children per women, population growth rate is estimated to be 2.7% per year and contraceptive prevalence rate is only 15% while the unmet need for family planning is 34%. Overall awareness of Family Planning methods is high, at 87%. The prevalence of long acting and permanent contraceptive methods (LAPMs) in Tigray region was very low which accounts for 0.1% for implants and no users for intra-uterine contraceptive device (IUCD) and female sterilization. Moreover almost all modern contraceptive use in Ethiopia is dependent on short acting contraceptive methods. The objective of this study was to assess factors associated with utilization of long acting and permanent contraceptive methods (LAPM) among married women of reproductive age group in Mekelle town. Methods: A cross sectional community based survey was conducted from March 9-20, 2011. Multistage sample technique was used to select the participants for the quantitative methods whereas purposive sampling was used for the qualitative part of the study. Binary descriptive statistics and multiple variable regressions were done. Results: The study consisted of quantitative and qualitative data. From the quantitative part of the study the response rate of the study was 95.6%. Of the qualitative part two FGDs were conducted for each married women and married men. 64% of the married women heard about LAPMs. More than half (53.6%) of the married women had negative attitude towards practicing of LAPMs. The overall prevalence of LAPMs use was 12.3% however; there were no users for female or male sterilization. The main reason cited by the majority of the married women for not using LAPMs was using another method of contraception 360 (93.3%). Mothers who had high knowledge were 8 times more likely to use LAPMs as compared with those who had low knowledge (AOR = 7.9, 95% CI of (3.1, 18.3). Mothers who had two or more pregnancies were 3 times more likely to use LAPM as compared with those who had one pregnancy (AOR = 2.7, 95% CI of (1.4, 5.1). Conclusion: A significant amount of the participants had low knowledge on permanent contraceptive particularly vasectomy. More than half (53.6%) of married women had negative attitude towards practicing of LAMPs. Few of married women use female sterilization and none use of female sterilization and or vasectomy. Positive knowledge of LAMPs, women who had two and above pregnancies and women who do not want to have additional child were significantly associated. Information education communication should focus on alleviating factors hinder from practicing of LAPMs

CD4 Count Progression of Adult HIV Patients Under Art Follow Up At Mekelle General Hospital, Tigray Region: A Longitudinal Data Analysis Approach

Background: The number of people receiving antiretroviral therapy (ART) in low- and middle-income countries continues to show encouraging growth, indicating that the global effort to scale up HIV treatment has exceeded 15 million people by the end of 2015.  Methods: A retrospective cohort study, comprising of the quantitative method of data collection was conducted among randomly selected 210 adult ART users enrolled in the first 6 months of 2011 and followed up to mid-2016 which is a five year follow up. Data were analyzed using a linear mixed model to identify the determinant factors, which importantly incorporates the effect of factors over time.  Results: Ninety-five (45%) were males and 115 (55%) were females. Composition of patients’ WHO clinical stage were; stage I (25 (11.8%)), stage II (30 (14.2%)), stage III (102 (48.8%)), and stage IV (52 (24.6%)). The mean CD4+ count at baseline was 218 cells. The progression of CD4+ count for males is lower than that of female over time (coef. =-0.0779, p-value=0.0062). There was a direct relationship between time in month and CD4+ count progression i.e., the CD4+ count progression of the adult HIV patients was increasing during the subsequent number of times measured or followed up under the ART clinic (coef. = 0.0435, p-value=0.0000). Patients with WHO stage II (coef. = -0.0982, p-value=0.0109) , stage III (coef. = -0.0884, p-value = 0.0010) and stage IV (coef. = 0.0859, p-value = 0.0095) had lower CD4+ count than the reference category WHO clinical stage I over time.  Conclusion: In conclusion, we found that the WHO clinical stage, Time, Weight, Gender and the Interaction effects of Weight with Time were significantly associated with the progression of CD4+ counts over time.&nbsp

Socio-cultural perceptions that influence the choice of where to give birth among women in pastoralist communities of Afar region, Ethiopia:A qualitative study using the health belief model

Background: Facility-based delivery care provided by skilled birth attendants is globally considered to be crucial in reducing maternal mortality and morbidity. Although home deliveries are discouraged in Ethiopia due to an associated higher risk of maternal mortality or morbidity, the majority of women in the Afar region continue to deliver at home. Numerous barriers contribute to the low utilization of health facility delivery and skilled birth attendance services in the Afar region. Objective: Investigate the perceptions and decision-making processes of pastoralist women from Afar regarding home and institutional childbirth using the health belief model. Methods: A qualitative study was conducted to examine the socio-cultural perceptions that influence the decisionmaking of Afar women who utilize institutional delivery services and those who deliver at home. A total of 13 women aged 17 to 45 who gave birth within the past four years before the data collection period were selected, based on a purposive selection strategy, and took part in in-depth interviews. Atlas.ti 7 software was used for deductive content analysis. Upcoming themes were assigned to pre-determined constructs of the health belief model. Results: The main barriers to the demand, access and use of facility-based delivery were lack of awareness regarding the risks of childbirth; lack of support from social networks; the strong impact of husbands' opinions; difficulties associated with discussing reproductive health issues; the reliance on traditional birth attendants; lifestyle factors; cultural needs; and distrust in skilled birth attendants and health facilities. The factors that motivated women to use delivery services provided by skilled birth attendants were associated with strong communal and kinship support; antenatal care visits; high awareness of pregnancy-related risks; the influence of previous negative birth experiences; and the belief that facility-based delivery brings faster recovery from birthrelated wounds. Conclusions: The data give in-depth insights into a range of socio-cultural factors that prevent or facilitate the choice of institutional delivery. Based on our findings, recommendations to increase the uptake of institutional delivery services should focus on community and family involvement, as well as on individual factors. Similarly, effective integration of traditional birth attendants should be encouraged to advise mothers to utilize reproductive, maternal and neonatal health services, and arrange a timely referral of women to emergency obstetric care. Furthermore, making facility-based care more culturally attractive to the needs of pastoralist women should be addressed in future interventions

Evaluation of the performance of Abbott Panbio™ COVID-19 antigen rapid diagnostic test for the detection of severe acute respiratory syndrome coronavirus 2 at Harar, Eastern Ethiopia

BackgroundRapid antigen tests can help in the effective isolation of symptomatic cases and the systematic tracing of close contacts. However, their reliability must be validated before implementing them widely.MethodsA cross-sectional study was conducted on 236 COVID-19-suspected patients visiting four different health institutions in Harari Regional State, Harar, Eastern Ethiopia, from June to July 2021. Two nasopharyngeal samples were collected and processed by the Panbio™ Ag-RDT kit and qRT-PCR. The collected data were analyzed using SPSS version 25.0.ResultsThe Panbio tests had a sensitivity of 77.5% (95% CI: 61.6–89.2%) and a specificity of 98.5% (95% CI: 95.6–99.7%). It also had a positive predictive value of 91.2% (95% CI: 76.9–96.9%), a negative predictive value of 95.5% (95% CI: 92.3–97.4%), and a kappa of 0.81 (95% CI: 0.7–0.9). The test had a sensitivity of 94.4%, 100%, 100%, and 90% in the samples collected from patients within the 1–5 days post-onset of COVID-19 signs and symptoms, of age group ≤18 years old, with cycle threshold values of <20, and with household contact, respectively.ConclusionThis test can be used as point-of-care testing for the diagnosis of symptomatic patients with short clinical courses and contact with patients in households

Non-communicable diseases in Ethiopia: policy and strategy gaps in the reduction of behavioral risk factors

Introduction: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Over 80% of NCD deaths occur in developing countries. Four modifiable behaviors, namely tobacco use, consumption of unhealthy diet, physical inactivity, and the harmful use of alcohol, contribute to 80% of the NCD burden. Studies show that the vast majority of NCDs can be prevented through behavioral risk-reduction interventions. Properly executed, the interventions could lead to a decrease in the burden of NCDs, ranging from a 30% drop in the prevalence of cancer to a 75% reduction in cardiovascular diseases. This study examined the policy and strategy gaps in the reduction of the modifiable NCD behavioral risk factors in Ethiopia to inform and guide policy-makers and other stakeholders. Methodology: This study used a data triangulation methodology with a sequential, explanatory, mixed-method design conducted in two stages. The authors carried out quantitative analysis on the prevalence and distribution of behavioral risk factors from the Ethiopia NCD STEPwise approach to surveillance (STEPS) survey. Qualitative data on national policies and strategies complemented the analysis of the progress made so far and the existing gaps. Results and Discussion: Ethiopia has made substantial progress in responding to the NCD epidemic by developing a health sector NCD strategic action plan, generating evidence, and setting time-bound national targets on NCD behavioral risk factors. Activities mainly aimed at reducing tobacco use, such as implementation of the ratified WHO Framework Convention on Tobacco Control (FCTC), using evidence of the Global Adult Tobacco Survey (GATS), and the articulation of legislative measures are ongoing. On this paper our analysis reveals policy and strategy gaps, status in law enforcement, social mobilization, and awareness creation to reduce the major behavioral risk factors. Conclusions: NCDs share common risk factors and risk reduction strategies creates an opportunity for an effective response. However, the national response still needs more effort to have a sufficient impact on the prevention of NCDs in Ethiopia. Thus, there is an urgent need for the country to develop and implement targeted strategies for each behavioral risk factor and design functional, multisectoral coordination. There is also a need for establishing sustainable financial mechanisms, such as increasing program budgets and levying ‘sin taxes,’ to support the NCD prevention and control program. Ethiop. J. Health Dev. 2019; 33(4):259-268] Key words: NCDs, behavioral risk factors, policy, strategy, multisectoral coordination, Ethiopi

Non-communicable Diseases in Ethiopia: Disease burden, gaps in health care delivery and strategic directions.

Abstract Introduction: In Ethiopia, non-communicable diseases (NCDs) cause 42% of deaths, of which 27% are premature deaths before 70 years of age. The Disability Adjusted Life Years (DALYs) increased from below 20% in 1990 to 69% in 2015. With no action, Ethiopia will be the first among the most populous nations in Africa to experience dramatic burden of premature deaths and disability from NCDs by 2040. However, the national response to NCDs remains fragmented with the total health spending per capita for NCDs still insignificant. The focus of this paper is highlighting the burden of NCDs in Ethiopia and analyzing one of the two major WHO recommended policy issues; the status of integrated management of NCDs, in Ethiopia. NCDs are complex conditions influenced by a range of individual, social and economic factors, including our perceptions and behavior. Also, NCDs tend to be easily overlooked by individuals and policy makers due to their silent nature. Thus, effectively addressing NCDs requires a fresher look into a range of health system issues, including how health services are organized and delivered.Methods: A mixed method approach with quantitative and qualitative data was used. Quantitative data was obtained through analysis of the global burden of diseases study, WHO-STEPs survey, Ethiopian SARA study and the national essential NCD drug survey. This was supplemented by qualitative data through review of a range of documents, including the national NCD policies and strategies and global and regional commitments.Results and discussion: In 2015, NCDs were the leading causes of age-standardized death rate (causing 711 deaths per 100,000 people (95% UI: 468.8–1036.2) and DALYs. The national estimates of the prevalence of NCD metabolic risk factors showed high rates of raised blood pressure (16%), hyperglycemia (5.9%), hypercholesterolemia (5.6%), overweight (5.2%) and Obesity (1.2%). Prevalence of 3-5 risk factors constituting a metabolic syndrome was 4.4%. Data availability on NCD morbidity and mortality is limited. While there are encouraging actions on NCDs in terms of political commitment, lot of gaps as shown by limited availability of resources for NCDs, NCD prevention and treatment services at the primary health care (PHC) level. Shortage of essential NCD drugs and diagnostic facilities and lack of treatment guidelines are major challenges. There is a need to re-orient the national health system to ensure recognition of the NCD burden and sustain political commitment, allocate sufficient funding and improve organization and delivery of NCD services at PHC level. [Ethiop. J. Health Dev. 2018;32 (3):00-000]Key words: Non-communicable diseases, health-system re-orientation, NCD burden, metabolic risk factors, Service delivery, Primary Health Car

Tobacco use and its predictors among Ethiopian adults: A further analysis of Ethiopian NCD STEPS survey-2015

Background: Consuming any form of tobacco is one of the leading causes of preventable morbidity and mortality. Tobacco smoking has been identified as one of the major risk factors for NCDs, including cardiovascular, chronic respiratory diseases, and different cancers. Although there is national information on magnitude of tobacco use, to date there is limited nationally representative data on factors associated with tobacco use. The aim of this study is to assess the distribution and predicators of tobacco use in Ethiopian adult population between 15 -59.Objectives: The main aim of this study was to assess the prevalence of tobacco use and its predictor in Ethiopia.Methods: A cross-sectional population based study design was employed among population age from 15- 69 years. A stratified, three-stage cluster sampling was used to identify the study subjects. Households in each cluster were selected using simple random sampling method. The sampling frame was based on the population and housing census conducted for Ethiopia in 2007. Data was collected using WHO NCD STEPS questionnaire; current tobacco use of any type was taken as the dependent variable. Five hundred thirteen enumeration areas (EAs) as primary sampling units (PSUs) (404 rural and 109 urban) were selected with probability proportionate to size, followed by selection of households as a secondary sampling units (SSUs). A total of 10,260 households were selected from the 513 EAs (20 households per EA). Eligible individuals were selected from households using Kish method (a pre-assigned table of random numbers to find the person to be interviewed). Descriptive statistics using frequency table, mean, median, interquartile range and standard deviations were computed. Step wise logistic regression was used to analyse the predictors of tobacco use. An Estimator of 95% confidence interval was used both for computing descriptive statistics as well testing associations using logistic regression.Results: The prevalence of tobacco use (all tobacco products) was 4.2%. The mean age (± SD) of starting tobacco use was 21(7) years. The mean frequency of tobacco use was 2 times per day. Hierarchical Logistic regression analysis revealed that participants in age groups 30-44 years, and 60-69 years were less likely to use any tobacco type compared to younger age group of15-29 years. Heavy episodic drinking, AOR 2.46 [95% CI= 1.4 – 4.5], and khat chewing, AOR 4.71[95%= 2.26 – 9.8], were independently associated with tobacco use.Conclusion and recommendations: The overall prevalence of tobacco use was relatively higher in males. Factors associated with tobacco use were heavy episodic drinking and khat chewing. Although tobacco use is an important risk factor for different disease on its own, the additional use of these substances exposes individuals to increased risk of NCDs. The findings warrant the need to implement existing anti-tobacco laws in the country, enhance anti-tobacco awareness raising efforts, and implement interventions to help current tobacco users, focusing attention more on regions with high rates of tobacco use and males. Key words: Ethiopia, NCDs, Predictors, Risk factors, Tobacco use, WHO STEP