The effect of dams and seasons on malaria incidence and anopheles abundance in Ethiopia

Background: Reservoirs created by damming rivers are often believed to increase malaria incidence risk and/or stretch the period of malaria transmission. In this paper, we report the effects of a mega hydropower dam on P. falciparum malaria incidence in Ethiopia. Methods: A longitudinal cohort study was conducted over a period of 2 years to determine Plasmodium falciparum malaria incidence among children less than 10 years of age living near a mega hydropower dam in Ethiopia. A total of 2080 children from 16 villages located at different distances from a hydropower dam were followed up from 2008 to 2010 using active detection of cases based on weekly house to house visits. Of this cohort of children, 951 (48.09%) were females and 1059 (51.91%) were males, with a median age of 5 years. Malaria vectors were simultaneously surveyed in all the 16 study villages. Frailty models were used to explore associations between time-to-malaria and potential risk factors, whereas, mixed-effects Poisson regression models were used to assess the effect of different covariates on anopheline abundance. Results: Overall, 548 (26.86%) children experienced at least one clinical malaria episode during the follow up period with mean incidence rate of 14.26 cases/1000 child-months at risk (95% CI: 12.16 -16.36). P. falciparum malaria incidence showed no statistically significant association with distance from the dam reservoir (p = 0.32). However, P. falciparum incidence varied significantly between seasons (p < 0.01). The malaria vector, Anopheles arabiensis, was however more abundant in villages nearer to the dam reservoir. Conclusions: P. falciparum malaria incidence dynamics were more influenced by seasonal drivers than by the dam reservoir itself. The findings could have implications in timing optimal malaria control interventions and in developing an early warning system in Ethiopia

Knowledge, Attitude and Practice of Trained Traditional Birth Attendants on HIV/AIDS Prevention in Jimma Town, Southwest Ethiopia

Background: HIV/AIDS is a global pandemic with cases being reported from virtually every country in the world. There is a growing awareness in many African countries that trained traditional birth attendants have a major role to play in HIV/AIDS prevention. However, information on their knowledge, attitude and practice concerning prevention of the disease is scarce. Therefore, this study was designed to assess their knowledge, attitude and practice and document baseline data for the study area. Methods: A cross-sectional survey was conducted from October 25 to 30, 1999 on all the 30 trained traditional birth attendants serving in Jimma town in order to assess their knowledge, attitude and practice in the prevention of HIV/AIDS. A pre-tested, structured questionnaire was used to collect the data. Attitude was measured using a Likert scale. Results: All the 30 trained traditional birth attendants responded making a response rate of 100%. The study revealed that the majority, 17/30 (56.7%) were above the ages 50 years (mean +SD = 54 + 10), Christians, 19/30(63.3%), oromo, 11/36 (36.7%) and illiterate, 21/30(70%). It also showed that 70%, 80% and 70% of the study population had “good knowledge”, “favorable attitude” and “ safe practice”, respectively. However, 26.7% and 60% responded that shaking hands with AIDS patients and insect bite respectively were considered to be risky to transmit HIV infection by of the study population. Moreover, majority (60%) feels that AIDS patients should be isolated and 23.3 % reported to assist delivery bare handed. Health institutions and radio were reported to be the main sources of information on HIV/AIDS. Conclusion: Although majority of the study population does have good knowledge, favorable attitude and safe practice, there are some misconceptions on the modes of transmission of HIV/AIDS. Moreover, the majority is in favor of isolation of AIDS patients and some are practicing unsafely. Therefore, series of refreshment courses on the ways and means of HIV/AIDS transmission and prevention and safe delivery practices are recommended. Further large-scale study is also recommended.Ethiop J Health Sci Vol. 11, No. 2 July 200

Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples' Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. METHODS: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. RESULTS: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age- and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level age-adjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude 15°C, and the use of open defecation by household members. CONCLUSION: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement)

Prevalence of Trachoma from 66 Impact Surveys in 52 Woredas of Southern Nations, Nationalities and Peoples' and Sidama Regions of Ethiopia, 2017-2019.

PURPOSE: Trachoma is endemic in Southern Nations, Nationalities and Peoples' (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation - follicular (TF) among children aged 1 - 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions. METHODS: From 2017 - 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children's Fund/WHO Joint Monitoring Programme questionnaire. RESULTS: By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 - 6-year-olds and 7 - 9-year-olds than 1 - 3-year-olds. CONCLUSION: Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Child Labor and Associated Problems in a Rural Town in South West Ethiopia

Background: Child labor is the single most common form of child abuse and neglect in the world today. It includes both paid and unpaid work and activities that are mentally, physically, socially or morally dangerous and harmful to children. However, information on the magnitude of the problem is scarce. Objective: To determine the magnitude of child labor and problems associated with it in Shebe rural town, South West Ethiopia. Methods: A cross sectional study was conducted in January 2001 to assess problems associated with child labor. Data were collected using a structured questionnaire addressed to children between ages 5-14 years inclusive. Systematic sampling technique was used and a total of 289 children were interviewed. Data collected included the sociodemographic characteristics of parents and children, variables on economic activity, schooling, conditions of work, work related injuries as well as abuses and exploitation faced at work. Result: Overall 78.9% of the children were working, either as paid workers (15.3%) or unpaid family workers (63.7%). The common sectors of work were domestic (56.4%) followed by agriculture (11.1%). More girls than boys are working. 31.2% of child workers spent on averagemore than 8 hours per day. Abuses encountered at work were verbal/emotional (49.6%), physical (27.2%) and sexual (2.2%). Schoolwork had been widely practiced as the result of which 31.7% of the working children had encountered work related injuries, out of which 1.8% had disabilities. Conclusion: The study revealed that child labor was widely practiced. It had affected the children's health and schooling. It had also predisposed them to exploitation and different forms of abuse. Based on these findings recommendations are made. [Ethiop.J.health Dev. 2003;17(1):45-52

Prevalence of trachoma after antibiotic mass drug administration in Tigray Region, Ethiopia: results from 42 trachoma impact surveys in 31 woredas

Purpose: Following baseline surveys in Tigray region in 2013. Since then, rounds of azithromycin mass drug administration (MDA) have been delivered in line with international guidance. The purpose of these surveys was to assess TF prevalence following those treatments to enable the region to plan the next steps towards elimination of trachoma. Methods: All surveys followed WHO recommendations for community-based cross-sectional survey design. 31 woredas in 6 zones of Tigray region were surveyed. There were two survey series: all 31 woredas were surveyed in the first series of surveys, and 11 woredas were resurveyed in the second. 20 woredas had one survey and 11 woredas had two surveys in the reported period. Results: In the first series of 31 surveys, one woreda had an adjusted TF prevalence in 1−9-year-olds of <5.0%, 13 had a prevalence of 5.0−9.9% and 17 had a prevalence of 10.0−29.9%. In the second series of 11 surveys, the prevalence of TF was <5.0% in seven woredas and 5.0−9.9% four woredas. The most recent adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was ≥0.2% in 27 EUs. One-third of households visited had access to an improved drinking water source within a 30-minute return journey of their house and 11% had an improved latrine. Conclusion: Eight EUs met the criteria to stop MDA for two years before re-survey. However, further rounds of MDA, additional efforts to improve water and sanitation access and ongoing strengthening of surgical services for TT are needed across Tigray