Beliefs and intention of heterosexual couples about undertaking Couple's HIV Testing and Counselling (CHTC) services in Ethiopia

Background: Couples HIV Testing & Counselling (CHTC) service is an approach that may enable more people to be reached and tested for HIV. However, little is known about how couples may use this service and what they think about CHTC as an approach to finding out their HIV status. This study aimed to understand how individuals who had ever been in an ongoing heterosexual relationship for 6 months or more intended to use CHTC in Ethiopia and their beliefs about its benefits and potential harms. Methods: Qualitative in-depth interviews were conducted in Addis Ababa, the capital city of Ethiopia, in 2017. Semi-structured interviews were undertaken with individuals who had ever been in an ongoing heterosexual relationship (n = 21) and key-informants (n = 11) including religious leaders, health care providers, and case managers. The interviews were transcribed verbatim, and an inductive thematic analysis was conducted. The data were coded to look for concepts and patterns across the interviews and relevant themes identified which captured key aspects related to the individual's views on undertaking HIV testing with a sexual partner. Results: Most participants regarded CHTC as an important HIV testing approach for people who are in an ongoing heterosexual relationship and expressed the view that there was "nothing like testing together". However, many of the individual participants revealed they would prefer first to get tested alone to find out their own HIV status. They feared the consequences if they were HIV-positive, including accusations of infidelity, relationship break-up, and being exposed in the community. Many also reported being pressured to undertake CHTC before marriage by a third party, including religious institutions. Key informant interviews also discussed the requirements for CHTC before marriage. Conclusion: The findings of this study suggest that people may be concerned about undertaking couples HIV testing without prior individual HIV testing. The intention of many to first test alone has policy and cost implications and underscores the possible harms of the implementation of CHTC in Ethiopia. Future research should examine whether the views identified in this qualitative study are reflected more broadly among couples in the community

Medical waste management-related factors affecting health and experiences of health risks among medical waste handlers in low and middle-income countries: A systematic review protocol of qualitative studies

Introduction Medical waste management (MWM)-related factors affecting the health of medical waste handlers (MWHs) and their health risks in low and middle-income countries (LMICs) are an important public health concern. Although studies of MWM-related factors and health risks among MWHs in LMICs are available, literature remains undersynthesised and knowledge fragmented. This systematic review will provide a comprehensive synthesis of evidence regarding the individual, system and policy-level MWM-related factors that affect MWHs' health and their experiences of health risks in LMICs. Methods and analysis All qualitative studies published in peer-reviewed journals between 1 July 2011 and 30 June 2021 with full texts available and accessible will be included in the review. Seven specific electronic databases (eg, Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, ProQuest and PsycINFO) will be searched. Two authors will review the citations and full texts, extract data and complete the quality appraisal independently. A third reviewer will check discrepancies when a consensus cannot be reached on differences between the two reviewers. Data extraction will be conducted using the Joanna Briggs Institute standardised data extraction form for qualitative research. The quality of articles will be assessed using a Critical Appraisal Skills Programme checklist. Results from eligible articles will be synthesised into a set of findings using the thematic framework analysis approach and will be reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. Ethics and dissemination This review is based on published articles, which does not require ethical approval because there is no collection of primary data. Findings from this review will be published in a peer-reviewed journal and presented at relevant public health conferences. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). PROSPERO registration number CRD42020226851

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Clinical Profiles of Cardiovascular Diseases and Predictors of Outcome of Hospitalization in a Tertiary Teaching Hospital, Ethiopia: A Prospective Observational Study

Abraha Hailu,1 Kibreab Gidey,1 Mohamedawel Mohamedniguss Ebrahim,2 Yonas Berhane,1 Teklay Gebrehaweria Baraki,1 Tesfay Hailemariam,1 Ataklti Negash,1 Habtamu Mesele,1 Tekleab Desta,1 Haylsh Tsegay,1 Mulubirhan Assefa,3 Alemayehu Bayray3 1Department of Internal Medicine, School of Medicine, Mekelle University-College of Health Sciences, Mekelle, Tigray, Ethiopia; 2Department of Biostatistics, School of Public Health, Mekelle University-College of Health Sciences, Mekelle, Tigray, Ethiopia; 3Department of Epidemiology, School of Public Health, Mekelle University-College of Health Sciences, Mekelle, Tigray, EthiopiaCorrespondence: Abraha Hailu, Department of Internal Medicine, Cardiology Unit, School of Medicine, Mekelle University-College of Health Sciences, Mekelle, Tigray, Ethiopia, Tel +251911413363, Email [email protected]: Documentation of cardiovascular diseases (CVDs) including major contributors to hospitalization and their outcomes in sub-Saharan Africa and Ethiopia is important to prioritize further research, prevention and treatment strategies.Objective: This study aimed to describe the clinical profiles of CVD admissions, risk factors, and patient outcomes at Ayder Comprehensive Specialized Hospital (ACSH) in Tigray, Ethiopia.Methods: Data of patients with the diagnosis of CVD was collected prospectively from Nov. 1, 2017 – Oct. 31, 2018 for patients admitted to medical wards and ICU of ACSH. Socio-demographic profiles, final admission diagnosis, duration of hospital stay and outcomes of hospitalization were variables recorded using a data abstraction checklist. Diseases were categorized using the World Health Organization’s International Classification of Diseases (ICD)-10 coding system. Data was analyzed using SPSS version 26.Results: Of the 2084 admissions over 1 year period, 767 (36.5%) had CVDs. The mean age of the study population was 53.4 ± 19.4 years with 55% females. Leading CVD admissions were stroke (35%), Venous thromboembolism (17%), rheumatic heart disease (RHD) (16.2%), ischemic heart disease (IHD) (11.3%) and cardiomyopathy (CMP) (7.4%). Heart Failure (HF) was found in 300 (39.1%) patients with structural heart disease. The structural cardiac lesions in those with HF were RHD (36%), CMP (19%), IHD (18%) and Cor pulmonale (9%). The in-hospital mortality of all CVD admissions was 13.2%. Of the total 101 CVD deaths most were because of stroke (n=37, 36.6%) followed by IHD (18.8%). Hypertension was the most frequent risk factor (28.8%).Conclusion: This study shows stroke to be the most common form of CVD and RHD to be the main reason for HF among hospital admissions in Northern Ethiopia, ACSH. Hypertension is the leading reported risk factor and hence the need to give high priority to hypertension and RHD control programs.Keywords: cardiovascular disease, admissions, outcomes, sub-Saharan Africa, Ethiopi

Reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome

OBJETIVO Analisar aspectos reprodutivos e conhecimento sobre planejamento familiar de mulheres com síndrome da imunodeficiência adquirida (Aids). MÉTODO Estudo transversal, descritivo, realizado de janeiro a dezembro de 2015, no ambulatório de infectologia de um hospital em Fortaleza, Ceará. Os dados foram coletados por meio de formulário, aplicado por entrevista em ambiente privativo. RESULTADOS Participaram do estudo 102 mulheres. A maioria delas teve conhecimento da sorologia positiva para vírus da imunodeficiência humana (HIV) durante o pré-natal (96,1%), e estas não pretendiam mais ter filhos (63,7%). Mulheres com idade menor que 39 anos, maior escolaridade e menor tempo de terapia antirretroviral tiveram maiores chances de ter filhos (p≤0,05). Mulheres com idade menor que 39 anos e maior escolaridade tiveram maiores chances de ter informações corretas sobre ter filhos na vigência do HIV (p≤0,05). Ter parceiro fixo aumentou a chance de desejar ter filhos, enquanto a laqueadura tubária foi maior em mulheres que não receberam orientações sobre planejamento familiar. CONCLUSÃO A maioria das mulheres com Aids não pretendem mais ter filhos. O conhecimento sobre o planejamento familiar foi limitado por falta de orientações pelos profissionais de saúde.OBJETIVO Analizar aspectos reproductivos y el conocimiento acerca de planificación familiar de las mujeres con síndrome de inmunodeficiencia adquirida (SIDA). MÉTODO Estudio transversal, descriptivo realizado de enero a diciembre de 2015, en la sala de enfermedades infecciosas de un hospital de Fortaleza, Ceará. Los datos fueron recolectados a través de una entrevista semiestructurada de forma de cuestionario en un ámbito privado. RESULTADOS El estudio incluyó a 102 mujeres. La mayoría de ellos tenían conocimiento de ser seropositivas para el virus de la inmunodeficiencia humana (VIH) durante la atención prenatal (96,1%), y que no tenía intención de tener más hijos (63,7%). Mujeres menores de 39 años, con educación superior y terapia antirretroviral más corta eran más propensas a tener hijos (p=0,05). Mujeres con edades de menos de 39 años y más educación tenían más probabilidades de tener la información correcta acerca de tener hijos en presencia del VIH (p=0,05). Tener pareja estable aumentó la posibilidad de desear tener hijos, mientras que la ligadura de trompas fue mayor en las mujeres que no han recibido orientación sobre la planificación familiar. CONCLUSIÓN La mayoría de las mujeres con SIDA no tienen intención de tener hijos. El conocimiento acerca de la planificación familiar se vio limitada por la falta de orientación por los profesionales de la salud.ABSTRACT OBJECTIVE To analyze the reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome (AIDS). METHOD Cross-sectional and descriptive study carried out from January to December, 2015, in the outpatient care of infectious disease unit in a hospital located in Fortaleza, Ceará. Data were collected through a form applied by interview in a private setting. RESULTS 102 women participated in the study. Most were aware that they were serologically positive with human immunodeficiency virus (HIV) during prenatal care (96.1%) and did not intend to have more children (63.7%). Women who were less than 39 years of age, had a higher educational level, and a shorter time of antiretroviral therapy had better chances of having children (p≤0.05). Having a steady partner increased the chance of desiring to have children, while tubal ligation was higher among women that did not receive counseling on family planning. Knowledge of family planning was limited because of lack of assistance provided by health professionals