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

Data on blueberry peroxidase kinetic characterization and stability towards thermal and high pressure processing

The data presented in this article are related to a research article entitled ‘Thermal and high pressure inactivation kinetics of blueberry peroxidase’ (Terefe et al., 2017) [1]. In this article, we report original data on the activity of partially purified blueberry peroxidase at different concentrations of hydrogen peroxide and phenlylenediamine as substrates and the effects of thermal and high pressure processing on the activity of the enzyme. Data on the stability of the enzyme during thermal (at temperatures ranging from 40 to 80 °C) and combined thermal-high pressure processing (100–690 MPa, 30–90 °C) are included in this report. The data are presented in this format in order to facilitate comparison with data from other researchers and allow statistical analyses and modeling by others in the field. Keywords: Blueberry, Peroxidase, Enzyme kinetics, Thermal processing, High pressure processin

Evaluation of the quality of cow milk consumed by children in and around Bahir Dar

The safety of dairy products with respect to food-borne diseases is a great public health concern around the world. The microbial load of milk is a major factor in determining its quality. Hence, this study was aimed to evaluate of the quality and hygienic practices of cow milk consumed by children in and around Bahir Dar. A total of 79 milk samples were collected and analyzed using standard bacteriological examination. The study revealed that the proportions of respondents who practice udder washing prior to milking were 56%, 22% and 2% in urban, periurban and rural areas, respectively. Moreover, 88.7%, 67.3% and 45.2% of respondents has a practice of milk boiling before feeding the milk to their children in the urban, peri-urban and rural areas of the study, respectively. The majority of respondents in the urban (88%) and peri-urban (50%) areas wash milking, milk feeding and storing containers with detergents and boiled water. Higher (SPC/ml) was found in the rural 5x105 areas of the study compared to the urban and peri-urban sites. Likewise, of SPC, higher CC (2.2x105) was obtained in the rural area of the study without significant (p > 0.05) difference in mean SPC across location. Therefore, milk collected from all study sites does not meet the minimum quality standard as the coliform population was much higher than the value indicated. Therefore, further research works to address constraints and to improve child milk consumption are imperative.Keywords: Bahir Dar, child milk consumption, milk qualit

Copigmentation with sinapic acid improves the stability of anthocyanins in high-pressure-processed strawberry purees

This study investigated the impact of copigmentation with sinapic acid on the stability of anthocyanins in strawberry purees of three commercial cultivars (Camarosa, Rubygem, and Festival) after high-pressure processing (HPP; 600 MPa/5 min) and thermal processing (TP; 88°C/2 min) and during three months of refrigerated storage. Copigmentation did not have a significant effect on the stability of anthocyanins during processing with 14% to 30% degradation observed with no significant difference among cultivars or the processing technique. On the contrary, copigmentation significantly (

Thermosonication for the Production of Sulforaphane Rich Broccoli Ingredients

A large proportion of broccoli biomass is lost during primary production, distribution, processing, and consumption. This biomass is rich in polyphenols and glucosinolates and can be used for the production of bioactive rich ingredients for food and nutraceutical applications. This study evaluated thermosonication (TS) (18 kHz, 0.6 W/g, 40–60 °C, 3–7 min) for the pre-treatment of broccoli florets to enhance enzymatic conversion of glucoraphanin into the bioactive sulforaphane. TS significantly increased sulforaphane yield, despite a decrease in myrosinase activity with increasing treatment intensity. The highest sulforaphane yield of ~2.9 times that of untreated broccoli was observed for broccoli thermosonicated for 7 min at 60 °C, which was 15.8% higher than the corresponding yield for thermal processing without sonication (TP) at the same condition. This was accompanied by increase in the residual level of glucoraphanin (~1.8 and 2.3 time respectively after TP and TS at 60 °C for 7 min compared to control samples) indicating that treatment-induced release of bound glucoraphanin from the cell wall matrix and improved accessibility could be at least partially responsible for the enhanced sulforaphane yield. The result indicates the potential of TS for the conversion of broccoli biomass into high sulforaphane broccoli-based ingredients

Thermosonication of Broccoli Florets Prior to Fermentation Increases Bioactive Components in Fermented Broccoli Puree

The aim of this study was to compare the effects of thermosonication (18 kHz at 60 °C for 7 min) pre-treatment with thermal treatment alone (60 °C for 7 min) of broccoli florets prior to pureeing and fermentation on selected bioactive components of fermented broccoli puree. Both thermal and thermosoncation pre-treatments significantly increased the rate of acidification of broccoli puree compared to control untreated broccoli puree, with the time to reach pH 4 being 8.25, 9.9, and 24 h, respectively, for thermally treated, thermosonicated, and control samples. The highest sulforaphane yield of 7268 µmol/kg dry weight (DW) was observed in the thermosonicated samples, followed by 6227 µmol/kg DW and 3180 µmol/kg DW in the thermally treated and untreated samples, respectively. The measurable residual glucoraphanin content was 1642 µmol/kg DW, 1187 µmol/kg DW, and 1047 µmol/kg DW, respectively, in the thermonsonicated, thermally pre-treated, and control fermented samples, indicating that pre-treatment specially by thermosonication increases the extractability of glucoraphanin. The higher sulforaphane yield in the thermosonicated and thermally pre-treated samples could be due to increased extractability and accessibility of glucoraphanin and interaction with myrosinase in addition to the inactivation of epthiospecifier protein (ESP), which directs conversion away from sulforaphane into sulforaphane nitrile

Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study

Background There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. Methods This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. Result Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. Conclusion The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151804/1/Gashaye etal_PlosOne_2019.pdfDescription of Gashaye etal_PlosOne_2019.pdf : Main articl