Sexual Behavior and Risk Perception of HIV Infection

Ethiopia is a developing country with a demographic profile dominated by a young population. Due to biological, psychological, socio cultural and economic factors, young people, particularly those aged 15-29 years, are generally at a high risk of HIV/AIDS and other reproductive health problems. This paper presented results of a cross-sectional descriptive study conducted in Bahir Dar Town, northwest Ethiopia, to assess sexual behavior and risk perception of HIV infection among youths .Both quantitative and qualitative method of data-collection methods were employed to conduct the study. For quantitative data collection, a household questioner survey was conducted among 232 youth, aged 15-29 years, within the 4kebeles (villages) of the town. Qualitative data were collected by conducting focus-group discussions and in-depth interviews with 17 participants. Descriptive statistics was used to characterize socio-economic, demographic and behavioral variables and the level of risk perception of HIV. Chi-square was used to examine the association of socio-economic, demographic and behavioral variables to HIV risk perception. Logistic regression model was used further examined to identify the prediction independent variables to risk perception. Data obtained by interview and focus group discussion were qualitatively analyzed. The minimum mean age at first sexual commencement was 16.71(+1.45) years and the maximum is 26.25(+1.18).Socio-economic and demographic variables such as Job(x²=4.7151, p=0.03), alcohol use(x²=16.8405, p=0.001), monthly income(x²=12.769,p=0.026), gender(x²=9.4788, p=0.002) and education status(x²=11.8883, p=0.003) were  significantly associated with risk perception of HIV among the youth. Behavioral variables such as sex ever had (²=10.1561,p=0.001), age at first sex (x²=7.524, p=0.023), no of sexual partners(²=7.2156, p=0.002 and knowledge of HIV status(x²=16.0624, p=0.000) were also significantly associated with risk perception of HIV among the youths. IN logistic regression model, age (z=-2.13, p=0.033), education status (z=-4.36, p=0.000), marital status (z=-2.48, p=0.013), alcohol use (z=4.88, p=0.000), and knowledge of HIV status (z=-3.69, p=0.000) were significantly and independently predicted HIV risk perception. In conclusion, further research should be conducted to better understand the nature of association between the above socio-economic and demographic, and sexual behavioral variables with risk perception of HIV/AIDS Staking behaviors. Keywords: sexual behavior, risk perceptions

Sexual Behavior and Risk Perception of HIV Infection Among Youths in Bahirdar Town

Ethiopia is a developing country with a demographic profile dominated by a young population. Due to biological, psychological, socio cultural and economic factors, young people, particularly those aged 15-29 years, are generally at a high risk of HIV/AIDS and other reproductive health problems. This paper presented results of a cross-sectional descriptive study conducted in Bahir Dar Town, northwest Ethiopia, to assess sexual behavior and risk perception of HIV infection among youths .Both quantitative and qualitative method of data-collection methods were employed to conduct the study. For quantitative data collection, a household questioner survey was conducted among 232 youth, aged 15-29 years, within the 4kebeles (villages) of the town. Qualitative data were collected by conducting focus-group discussions and in-depth interviews with 17 participants. Descriptive statistics was used to characterize socio-economic, demographic and behavioral variables and the level of risk perception of HIV. Chi-square was used to examine the association of socio-economic, demographic and behavioral variables to HIV risk perception. Logistic regression model was used further examined to identify the prediction independent variables to risk perception. Data obtained by interview and focus group discussion were qualitatively analyzed. The minimum mean age at first sexual commencement was 16.71(+1.45) years and the maximum is 26.25(+1.18).Socio-economic and demographic variables such as Job(x²=4.7151, p=0.03), alcohol use(x²=16.8405, p=0.001), monthly income(x²=12.769,p=0.026), gender(x²=9.4788, p=0.002) and education status(x²=11.8883, p=0.003) were  significantly associated with risk perception of HIV among the youth. Behavioral variables such as sex ever had (²=10.1561,p=0.001), age at first sex (x²=7.524, p=0.023), no of sexual partners(²=7.2156, p=0.002 and knowledge of HIV status(x²=16.0624, p=0.000) were also significantly associated with risk perception of HIV among the youths. IN logistic regression model, age (z=-2.13, p=0.033), education status (z=-4.36, p=0.000), marital status (z=-2.48, p=0.013), alcohol use (z=4.88, p=0.000), and knowledge of HIV status (z=-3.69, p=0.000) were significantly and independently predicted HIV risk perception. In conclusion, further research should be conducted to better understand the nature of association between the above socio-economic and demographic, and sexual behavioral variables with risk perception of HIV/AIDS Staking behaviors. Keywords: sexual behavior, risk perception

Key stakeholders and actions to address Lake Beseka’s challenges in Ethiopia: a social network approach

Lake Beseka is a shallow, saline, endorheic lake in the East African Rift Valley of Ethiopia that has dramatically grown in size due to large-scale irrigation development in its catchment area. Recent artificial connections of the lake with the Awash River system to contain lake size have led to a series of changes and impacts on different water users, but are not reflected in lake and Awash River governance and institutions. Understanding who are the key actors affecting Lake Beseka and strengthening their linkages can help identify solutions that sustainably contain or reduce the lake’s size, improve its water quality, and address costs to nearby and downstream populations as well as the environment. Thus, this study analyzed qualitative data collected from net-mapping – a network analysis that identifies actors or stakeholders as well as linkages and relative power positions among stakeholders. The resulting network reflects the complexity of the water governance system including upstream actors who affect the size and quality of the lake as well as downstream actors who suffer from adverse consequences. The Awash Basin Development Authority, Metehara Sugar Factory, regional bureaus, and federal ministries were identified as the most influential actors affecting how Lake Beseka is used and managed. Actors most affected by the lake expansion and quality problems such as downstream communities currently have no role in the governance of the lake. Metehara Municipality, woreda offices, research institutes, and farmers were considered to have moderate influence. Stakeholders who participated in the net-mapping workshops identified flooding, salinity, water-related conflict, and health effects as the four main challenges of the lake. The study suggests that developing multi-stakeholder partnerships or platforms across most influential and most affected actors could support a more comprehensive understanding of the multiple challenges Lake Beseka is posing. It could also foster the development of more integrated solutions that support the different stakeholders in the lake catchment area and the Awash River Basin

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+).

INTRODUCTION: Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the "model of care") and (ii) explore associations between the "model of care" and health facility-level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. METHODS: A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. RESULTS: Among 141 health facilities, four "models of care" were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the "model of care" applied; factors independently associated with ART retention were district location, patient volume and the "model of care" applied. CONCLUSIONS: A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the "model of care" chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations

Spatiotemporal climate and vegetation greenness changes and their nexus for Dhidhessa River Basin, Ethiopia

Background Understanding spatiotemporal climate and vegetation changes and their nexus is key for designing climate change adaptation strategies at a local scale. However, such a study is lacking in many basins of Ethiopia. The objectives of this study were (i) to analyze temperature, rainfall and vegetation greenness trends and (ii) determine the spatial relationship of climate variables and vegetation greenness, characterized using Normalized Difference in Vegetation Index (NDVI), for the Dhidhessa River Basin (DRB). Quality checked high spatial resolution satellite datasets were used for the study. Mann–Kendall test and Sen’s slope method were used for the trend analysis. The spatial relationship between climate change and NDVI was analyzed using geographically weighted regression (GWR) technique. Results According to the study, past and future climate trend analysis generally showed wetting and warming for the DRB where the degree of trends varies for the different time and spatial scales. A seasonal shift in rainfall was also observed for the basin. These findings informed that there will be a negative impact on rain-fed agriculture and water availability in the basin. Besides, NDVI trends analysis generally showed greening for most climatic zones for the annual and main rainy season timescales. However, no NDVI trends were observed in all timescales for cool sub-humid, tepid humid and warm humid climatic zones. The increasing NDVI trends could be attributed to agroforestry practices but do not necessarily indicate improved forest coverage for the basin. The change in NDVI was positively correlated to rainfall (r2 = 0.62) and negatively correlated to the minimum (r2 = 0.58) and maximum (r2 = 0.45) temperature. The study revealed a strong interaction between the climate variables and vegetation greenness for the basin that further influences the biophysical processes of the land surface like the hydrologic responses of a basin. Conclusion The study concluded that the trend in climate and vegetation greenness varies spatiotemporally for the DRB. Besides, the climate change and its strong relationship with vegetation greenness observed in this study will further affect the biophysical and environmental processes in the study area; mostly negatively on agricultural and water resource sectors. Thus, this study provides helpful information to device climate change adaptation strategies at a local scale

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

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

Exploring the experience of female middle managers in secondary schools of Jimma town, Ethiopia

This study aimed at exploring the experiences of female middle managers in secondary schools in Jimma town, with a specific focus on their preparation, motivation, support, training, development, perceptions, and challenges. To achieve this, a case study design was employed. Primary data were collected from female managers and educators at various levels within the schools. Purposive sampling was employed to select the participants. Data were collected from female principals, department heads, and unit leaders using interviewees. Focus group discussions were conducted with female educators. Moreover, government strategies, directives, guidelines, school plans, reports, and performance appraisals were reviewed. On top of these, physical observations of offices and work environments were conducted. The data were thematically categorized, coded, and analyzed verbatim. The findings revealed several critical issues. There was a lack of clear guidelines for competing for middle management positions and insufficient encouragement for female educators to assume management roles. Besides, there was a notable deficiency in support, structured training, and professional development opportunities for female middle managers. Challenges identified included inadequate support, student misbehavior, teacher unpunctuality and absenteeism, insufficient resources, poor working environments, difficulties in balancing work and life, and various personal, managerial, and social responsibilities. Based on these findings, it can be concluded that the managerial experiences of female middle managers in Jimma town's secondary schools were fraught with challenges, significantly impacting their effectiveness. Moreover, female middle managers did not receive adequate institutional support to fulfill their responsibilities. Therefore, it is advisable that Jimma town education office, in collaboration with secondary schools and concerned bodies, to focus on preparing, assigning, training, developing, and supporting female middle managers and educators to enable them to effectively carry out their managerial roles in secondary schools

Symptomatic remission and its associated factors among patients with schizophrenia on risperidone or olanzapine at Amanuel mental specialized hospital, Addis Ababa, Ethiopia

Abstract Background Schizophrenia is a debilitating condition that affects 1% of the global population. Understanding the prevalence and the factors predicting schizophrenia remission is crucial for healthcare providers. This study aimed to determine the prevalence of remission and factors affecting the remission. Cross-sectional study was conducted at the Amanuel Mental Specialized Hospital from 3 October, 2022, to 31 August, 2023, and included 271 participants. Remission was measured using Remission in Schizophrenia Working Group (RSWG) symptom severity-based criteria. Data analysis was done using SPSS V.25. Results The mean age of participants was 34.2 with standard deviation (SD) of 10.5 years. Most were male (90%), unmarried (63.8%), lived with their relatives (91.9%), and were unemployed (56.5%). Fifty-two percent achieved symptomatic remission. Remission in patients with medication switched to SGAs increased by 1.9 times compared to patients without medication switch (AOR 1.9, 95% CI: 1.1, 1.2). Adherent patients had 2.7 times higher odds of symptomatic remission as compared to non-adherent patients (AOR 2.7, 95% CI: 1.5,4.9), and for each unit increase in body mass index (BMI), the odds of achieving symptomatic remission were increased by 13% (AOR 1.13, 95% CI: 1.04, 1.23). The odds of symptomatic remission decreased by 71% in patients experiencing moderate-to-severe side effects compared to their counterparts (AOR 0.29, 95% CI: 0.1, 0.6). Conclusions Our study revealed a symptomatic remission was achieved in 141 (52%) of the subjects. There is a possibility to improve symptomatic remission with counseling on the importance of adherence, monitoring and managing side effects, and switching medication to either risperidone or olanzapine. Measuring remission using RSWG time-based criteria is recommended