Non-specialist delivery of the WHO Caregiver Skills Training Programme for children with neurodevelopmental disorders: stakeholder perspectives about acceptability and feasibility in rural Ethiopia

Background: Autism and other neurodevelopmental disorders (NDD) are common in low- and middle-income countries (LMIC). However, services to address the needs of this group in LMIC are almost non-existent. The World Health Organization (WHO) developed the Caregiver Skills Training (CST) programme to be suitable for delivery in diverse global contexts. Ethiopia, the country of focus in this study, has a largely rural population and a lack of specialist service providers. Additional contextual challenges, including poverty, low literacy, limited access to healthcare and a lack of specialist child mental health services, may undermine the delivery of CST in this setting. This thesis, therefore, seeks to explore the acceptability and feasibility of non-specialist delivery of the WHO-CST from the perspective of providers and caregivers in rural Ethiopia. Methods: In Chapter one, a general literature review of neurodevelopmental disability and caregiver skills training is presented, with a focus on sub-Saharan Africa, to help contextualise the main qualitative study, outlined in chapter two. In-depth interviews were conducted with caregivers (n=19) who were all participants in two rural pilot studies of the WHO-CST programme. In addition, three focus group interviews were conducted with non-specialist facilitators (n=8), who facilitated the CST programme in two rural pilot tests. Data were analysed using the framework approach. Results: Findings were mapped onto the three framework themes created for this analysis: 1) Programme content: caregivers and facilitators uniformly indicated that the adapted programme addressed a need and was relevant for their context; caregivers emphasised how the programme helped them understand their child's problems and improve their skills to support their children; facilitators highlighted having acquired new knowledge and skills relating to NDD; 2) Programme facilitation: caregiver responses suggested that programme facilitation by non-specialists was acceptable; non-specialist facilitators emphasised the importance of support and supervision for the facilitators and simplification and modification of some concepts, such as the concept of play, and 3) CST training approach and delivery: participants indicated that the training modalities, including home visits and group training, were acceptable and feasible in the local context. Conclusions: This study suggested that, with some contextually appropriate modifications of programme content and delivery and continuing supervision of facilitators, the WHO-CST programme facilitated by non-specialists would be acceptable and feasible in rural Ethiopia. Results from this study may be useful to fine-tune the implementation of non-specialist delivery of the CST programme in Ethiopia, as well as other LMIC

Family planning for women with severe mental illness in rural Ethiopia: a qualitative study

Background: Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI) there may be particular challenges and concerns. As primary care-based mental health care is expanded in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Aim: To explore the family planning experiences, unmet needs and preferences of women with SMI who reside in a predominantly rural area of Ethiopia Methods: A qualitative study design was used. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively on the basis of responses to a quantitative survey of current family planning utilization. In-depth interviews were conducted with 16 women with SMI who were of reproductive age until theoretical saturation was achieved. Audio files were transcribed in Amharic, translated into English and analysed using a Framework Approach using Open Code qualitative data analysis software. Results: The findings were grouped into four main themes. The first theme focused on the broader context of intimate relationships and sexual life of women with SMI. Sexual violence, assault and exploitation were reported by several respondents, underlining the vulnerability of women with SMI. Lack of control over sexual contact was associated with unwanted pregnancies. The second theme (childbearing and SMI) was around attitudes towards childbearing in women with SMI. Respondents described negative views from community members and some health professionals about the capacity of a woman with SMI to give birth and bring up a child. In most cases, it was assumed that a woman with SMI should not have a child at all. In the third theme (family planning for women with SMI), respondents spoke of their low access to information about family planning and systematic exclusion from existing services. In the fourth theme (preferred family planning services), the respondents had concerns about the ability of primary care workers to understand their specific family planning needs, but also valued proximity of the service and privacy. The importance of addressing health worker and community attitudes was emphasized. Conclusion: This study has provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group

LABORATORY NETWORK FOR HIV INFECTION IN ETHIOPIA

ABSTRACT: One of the main objectives of the Short Tern Plan of the Ethiopian AIDS Control Programme was the establishment of screening laboratories in blood banks in the country and strengthening the Immunology Laboratory of the National Research Institute of Health. As a result, HIV screening laboratories were established in all five blood banks and the National Referral Laboratory for AIDS (NRLA) was established during the first half of the short tenn plan. Based on the Medium Term Plan of the programme which envisaged establishment of HIV screening laboratories in all regional hospitals where a substantial amount of blood transfusion took place, HIV screening laboratories were established. To date there are 24 HIV screening laboratories throughout the country .Nineteen of these laboratories use ELISA tests and 5 use simple/rapid assays. There is a well established quality control and supervision system where each laboratory is visited twice a year and characterized panels of sera are sent to each laboratory three times a year from the NRLA. The plan of the National AIDS Control Programme is to establish screening laboratories in all establishments where blood transfusion is carried out

THE PREVALENCE OF HIV-1 ANTIBODIES IN 106 TUBERCULOSIS PATIENTS

ABSTRACT: Sera were collected from all 106 tuberculosis (TB) patients consecutively seen over a period of six months at the Armed Forces General Hospital. All were tested for the presence of HIV-I antibodies, using the ELISA (Wellcozyme) and confirmed with the Western Blot (Biorad), out of which 7 reacted positively. Six of the seven HIV-I positive patients had pulmonary tuberculosis and only one had the disseminated form as opposed to 31% of the 106 patients presenting with the latter. Five of the HIV -I positive patients had a history of sexually transmitted diseases (STD) compared to 30 of the 99 HIV-I negative patients (39.4%). The study seems to show a positive association between HIV-I infection and tuberculosis. We therefore believe that further studies should be done in this country in order to a certain the association between the two diseases

ELISA FALSE POSITIVITY IN RELATION TO HIV -1 PREVALENCE IN ETHIOPIA

ABSTRACT: A close investigation of data accumulated over several years at the National Referral Laboratory for AIDS (NRLA), revealed a certain pattern in the number of false positive results that occur in population groups with a given prevalence of HIV -1 infection. To provide more accurate information regarding this observation 8850 serum samples from females with multi-partner sexual contact (MPSC) residing in different regions of Ethiopia with varying HIV -1 prevalence rates, were collected and tested using 1st and 2nd generation enzyme immunoassays (EIA) and a western blot. The results obtained from this study suggest that the rate of the occurrence of false positive enzyme linked imrnuno-sorbent assay (ELISA) results during laboratory testing for HIV -1 antibody is (regardless of the quality of antigen used) inversely proportional to the prevalence of HIV-l in a given population group

Participatory tomato variety selection in the lowland areas of North Shewa

The production and productivity of tomatoes in Ethiopia as well as in Amhara Region are very low because of lack of improved and adapted varieties, inadequate knowledge of production and management, and a poor marketing system. The field experiment was carried out during the 2018 irrigation seasons at Ataye and Shewarobit to identify adaptive, high yielding and disease tolerant varieties of tomato. Eight improved tomato varieties were laid out in a randomized complete block design and replicated three times. The collected biological data were analyzed using SAS statistical software version 9.4, and farmers’ preferences for those varieties were also assessed based on selection attributes set by them. The combined analysis of variance revealed that there was significant difference between the varieties on the number of fruits per cluster, plant height, marketable number, unmarketable number and average weight of a tomato. The highest number of fruits per cluster was recorded from variety Mersa (3.83), followed by Melkasalsa (3.73) and Melkashola (3.7). The variety Mersa was the tallest followed by Weyno with plant heights of 110.5 cm and 110.96 cm, respectively.  The highest average fruit weight was recorded for the variety D2 (61.25 g) followed by Cochoro (46.46 g). Even though it was not statistically significant, the variety Melkashola has given the highest marketable yield (32.98 t ha-1) and showed a better reaction to late blight disease as low as 27.5 %. In addition to this, variety Melkashola was highly preferred by the farmers. Based on the biological data and farmer’s preference variety Melkashola has been recommended for Ataye and Shewarobit as well as for other similar agro-ecologies

HIV -1 INFECTION AND SOME RELATED RISK FACTORS AMONG FEMALE SEX WORKERS IN ADDIS ABABA

SUMMARY: A sero-epidemiological survey on HIV-l infection was carried out in July 1989, among four groups of female sex workers randomly selected in Addis Ababa. The four groups were comprised of: bar girls, tej (traditional wine) sellers, tella (traditional beer) sellers and females in red light houses. Sera were tested by ELISA and confirmed y western blot. The mean age of the 2617 females studied was 31.2 years, and the prevalence rate for HIV-1 was 24.7%. Persons in the 15-24 age group were affected more frequently. The highest prevalence (43.8%) was found among the females in red light houses. Females with relatively larger number of sexual partners and those who had previous exposure to STDs, had a higher prevalence of the infection. The survey revealed that HIV-1 is highly prevalent among females practicing multi-partner sexual contact (MPSC) in Addis Ababa, and the infection concentrates in the central areas of the city

HIV-1 INFECTION AND RELATED RISK FACTORS AMONG FEMALE SEX WORKERS IN URBAN AREAS OF ETHIOPIA

SUMMARY: A total of 6234 female sex workers practicing multi-partner sexual contacts (MPSC) from 23 urban areas of the country were tested for Human Immuno deficiency Virus type 1 (HIV1) infection, in 1988. The sample size ranged from 99 persons in Moyale, to 386 in Asmara. The mean age of the individuals studied was 24.2 years (ranging from 21.5 years to 27.1 years in the different towns). The HIV-1 prevalence rates varied from 1.3% (n=318) in Massawa, to 38.1% (n=312) in Dessie town; the mean for all towns being 17%. The highest prevalence rates were found in the towns along the road from Addis Ababa to Assab, in Bahr-Dar , Dessie and Mekele. The lowest prevalence rates were recorded in three towns of northern Ethiopia. This study indicated that Hiv-1 is widely spread in the urban areas of Ethiopia affecting female sex workers mainly in the 15-29 years age group. Previous episodes of other sexually transmitted diseases, and frequent change of sexual partners were identified as possible risk factors for HIV infection. Frequent mobility of these females may have played a significant role in HIV transmission between the towns

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