Incidence of Opportunistic Infections Among Adult HIV Positive People Receiving Co-trimoxazole Prophylaxis

In Ethiopia, Co-trimoxazole prophylaxis therapy (CPT) used to prevent opportunistic infections among people living with HIV is the standard of practice; however incidence of opportunistic infection and their predictors are rarely documented in the country. This was a retrospective follow up study to describe the incidence and predictors of opportunistic infections among 244 adults receiving CPT. Participants were followed for a median time of 72 weeks. During a study period a total of 53opportunistic infections were recorded; making the overall incidence rate 23.9/100 person-years. High incidence of opportunistic infections is likely to occur if: the clients were married (adjusted hazard ratio (AHR) 1.965;(95% CI: 1.109, 3.451), had history of tuberculosis treatment (AHR: 2.34(95% CI:1.05, 5.24)), patients who are indicated for CPT because of both clinical and WHO clinical staging criteria(AHR 2.418 (95% CI:1.02, 5.72 ),and had poor adherence to CPT (AHR, 2.11 (95% CI: 1.19-3.72)). Eventhough adherence is non-substitutable strategy to prevent opportunistic infection, the cohort of HIV patients failed to adhere to CPT, which in turn resulthigh incidence of opportunistic infections among them, therefore improving adherence as guideline should be a priority to prevent OIs among people living with HIV in the study region

Maternal Mortality in Rural South Ethiopia: Outcomes of Community-Based Birth Registration by Health Extension Workers

Introduction: Rural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR) in rural south Ethiopia. Methods: In 2010, health extension workers (HEWs) registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria). One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke. Results: We registered 10,987 births (81,4% of expected 13,492 births) with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71,6% (1,718) were registered with similar MMRs (474 vs. 439) between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths) occurred at home. Ninety percent (9,863 births) were at home, 4% (430) at health posts, 2,5% (282) at health centres, and 3,5% (412) in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0.051) and the villages had no road access (946 vs. 410; p= 0.039). The validation helped to increase the registration coverage by 10% through feedback discussions. Conclusion: It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

In a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work.In this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)).Our results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented

Reducing maternal deaths in Ethiopia: Results of an intervention programme in Southwest Ethiopia

Background: In a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work. Results: In this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24&ndash;0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2&ndash;4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P&lt;0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61&ndash;4.61)). Conclusions: Our results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented

Socio-demographic data on parents, services, and infrastructures in the birth registry districts of south Ethiopia in 2010.

<p>Note:</p><p>* Education: illiterate are those cannot read/write and had no formal education, literate include those who can read/write and completed higher education,</p><p>** 57% of households with births were within 10 km of health centres (10 km is the government target for access)</p><p>Socio-demographic data on parents, services, and infrastructures in the birth registry districts of south Ethiopia in 2010.</p

The profile of the birth registry.

<p>The profile of the birth registry.</p

The map of the study area within southern Ethiopia.

<p>The map of the study area within southern Ethiopia.</p