Maternal death review: a path to achieve the Millennium Development Goal of improving maternal health

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The countdown to 2020: measuring progress in neglected tropical diseases

The London Declaration on Neglected Tropical Diseases1 marked its fourth year on Jan 30, 2016. The declaration represents a coordinate effort to control or eliminate ten of the neglected diseases by 2020, and has already led to important coordination and partnership, and mobilised considerable resources. Although the progress made so far is to be celebrated, now is the time to count down to 2020 and start monitoring the progress and trends towards achieving the control and elimination targets

Neglected tropical disease targets must include morbidity

The Royal Society of Tropical Medicine and Hygiene is holding a 1-day meeting in London, UK, on Sept 25, 2015, to discuss “The disease elimination agenda: the role of science, policy and advocacy”.1 Important meetings such as this are a welcome forum at which to discuss progress and challenges and to reflect on important milestones, particularly with regard to neglected tropical diseases (NTDs). Such NTD milestones include the London declaration2 and the WHO roadmap.3 However, the success of these elimination initiatives is contingent on inclusive programming and on addressing the problem in its entirety

Determinants of delay in malaria treatment-seeking behaviour for under-five children in south-west Ethiopia: a case control study

<p>Abstract</p> <p>Background</p> <p>Prompt diagnosis and timely treatment of malaria within 24 hours after onset of first symptoms can reduce illness progression to severe stages and therefore, decrease mortality. The reason why mothers/caretakers delay in malaria diagnosis and treatment for under-five children is not well studied in Ethiopia. The objective of this study was to assess determinants of malaria treatment delay in under-five children in three districts of south-west Ethiopia.</p> <p>Methods</p> <p>A case control study was conducted from March 15 to April 20, 2010. Cases were under-five children who had clinical malaria and sought treatment after 24 hours of developing sign and symptom, and controls were under-five children who had clinical malaria and sought treatment within 24 hours of developing sign and symptom of malaria. Data were collected by trained enumerators using structured questionnaire. Data were entered in to Epi Info version 6.04 and analyzed using SPSS version 16.0. To identify determinants, multiple logistic regression was done.</p> <p>Results</p> <p>A total of 155 mothers of cases and 155 mothers of controls were interviewed. Mothers of children who were in a monogamous marriage (OR = 3.41, 95% CI: 1.39, 8.34), who complained about the side effects of anti-malarial drugs (OR = 4.96, 95% CI: 1.21, 20.36), who had no history of child death (OR = 3.50, 95% CI: 1.82, 6.42) and who complained about the higher cost of transportation to reach the health institutions (OR = 2.01, 95% CI: 1.17, 3.45) were more likely to be late for the treatment of malaria in under-five children.</p> <p>Conclusion</p> <p>Effective malaria control programmes should address reducing delayed presentation of children for treatment. Efforts to reduce delay should address transport cost, decentralization of services and increasing awareness of the community on early diagnosis and treatment.</p

Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia

Problem Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require the similar provision of care, but in 2012 the Ethiopian health system did not integrate the morbidity management. Approach To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers did integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. Local setting In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. Relevant changes To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts. Lessons learnt In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic

Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

Abstract Background Access to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care. Methods A case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA. Results PLHA who live with their families [OR = 3.29, 95%CI: 1.28-8.45)], lived in a rented house [OR = 2.52, 95%CI: 1.09-5.79], non-pregnant women [OR = 9.3, 95% CI: 1.93-44.82], who perceived ART have many side effects [OR = 6.23, 95%CI:1.63,23.82)], who perceived HIV as stigmatizing disease [OR = 3.1, 95% CI: 1.09-8.76], who tested with sickness/symptoms [OR = 2.62, 95% CI: 1.26-5.44], who did not disclose their HIV status for their partner [OR = 2.78, 95% CI: 1.02-7.56], frequent alcohol users [OR = 3.55, 95% CI: 1.63-7.71] and who spent more than 120 months with partner at HIV diagnosis[OR = 5.86, 95% CI: 1.35-25.41] were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care. Conclusions Efforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.</p

Determinants and outcomes of disclosing HIV-sero positive status to sexual partners among women in Mettu and Gore towns, Illubabor Zone southwest Ethiopia

Background: Disclosing one's HIV test result to a sexual partner is an important factor in HIV/AIDS prevention interventions. Disclosure of one's HIV status enables for improved access to prevention and treatment programs provides increased opportunities for risk reduction and helps in planning for the future. An assessment of the barriers and outcomes for disclosure is necessary to enhance HIV test result disclosure among couples. Objective: This study is aimed at determining the rate, barriers and out comes of HIV positive status disclosure among sexual partners. Method: A cross sectional study was conducted in Mettu and Gore towns of Illubabor Zone, south west Ethiopia. Sixty-seven women living with HIV out of which 42(62.7%) reported to had sexual partners and were eligible for the study and were interviewed. A structured questionnaire was used for data collection. Results: Overall 69% of the women reported that they had shared their HIV test results with their partners. Among the women who did not disclose their HIV status 62.5% said that it was due to fear of partner’s reaction (fear of abandonment, rejection and accusation of infidelity). But 75.9 % of HIV positive women who disclosed their result reported positive partner’s reaction. Most (81.3%) women who had prior discussion about HIV and HIV testing with their partners have disclosed their results (P<0.005). Condom use was also found to be high among couples that disclosed their HIV/status than those who did not do so (P<0.05). Conclusion: This study indicates that the outcomes of disclosure are encouraging. The anticipated partner reactions and the reality discovered by the study were different. Therefore it is important to assure HIV-positive women that the benefits of disclosure out weigh the potential risks. A large-scale study on the subject is also recommended

The impact of podoconiosis on quality of life in Northern Ethiopia

BACKGROUND Podoconiosis is one of the most neglected tropical diseases, which untreated, causes considerable physical disability and stigma for affected individuals. Little is known about the quality of life (QoL) of patients with podoconiosis. This study aimed to assess the QoL of patients with podoconiosis in comparison with healthy controls in Ethiopia. METHODS A comparative cross-sectional study was conducted in May 2012, among 346 clinically confirmed adult patients with podoconiosis, and 349 healthy adult neighbourhood controls in Dembecha woreda (district) in northern Ethiopia. QoL was assessed using the validated Amharic version of the World Health Organisation Quality of Life questionnaire (WHOQoL-BREF) scale; in addition, mental health and stigma were assessed by the Kessler-10 scale and podoconiosis stigma scale respectively. Logistic regression analysis was done to identify factors associated with QoL. RESULTS Patients with podoconiosis had significantly lower mean overall QoL than the controls (52.05 versus 64.39), and this was also true in all four sub domains (physical, psychological, social and environmental). Controls were 7 times more likely to have high (above median) QoL (Odds Ratio = 6.74, 95% Confidence Interval 4.62 to 9.84) than cases. Factors associated with lower QoL were: experiencing high levels of stigma, living in an urban area, being illiterate, having additional co-morbidities, and being unmarried. Mental illness was associated with lower scores in psychological and physical domains. CONCLUSIONS Programs targeting podoconiosis interventions should include QoL as an indicator for monitoring progress. Interventions targeting improvement of QoL among patients with podoconiosis should address depression, stigma and other co-morbidities