MEDICAL GEOGRAPHY : ITS ROLE IN DISEASE CONTROL AND HEALTH DEVELOPMENT IN AFRICA WITH PARTICULAR REFERENCE TO ETHIOPIA

ABSTRACTThis paper attempts to review selected medical geographical studies with objective of providing an overview of the sub field to geography and suggesting possible areas of collaboration with epidemiologists and public health officials in disease control programmes in Africa, particularly Ethiopia. A combination of: (1) complimentarity between medical geography and epidemiology; (2) the appropriateness of geography in analysing man-environment interactions; (3) the broad range of topics in disease ecology and health care delivery and utilization covered by medical geographers; (4) the need to evaluate aspects of the physical and socioeconomic environment in socialist Ethiopia for planning purposes and; (5) existence of viable programmes in medical geography in other African countries warrant consideration of this applied discipline in collaborative and interdisciplinary disease control programmes in Ethiopia

HIV/AIDS in Ethiopia: The Epidemic and Social, Economic, and Demographic Impacts

This paper reviews the epidemiology, driving forces and impacts of the HIV/AIDS epidemic in Ethiopia and evaluates prospects for prevention and control. After the rapid spread of HIV infection in the 1980s and 1990s primarily by commercial sex workers, truck drivers and soldiers along major transportation routes, children, adolescents and the general population are increasingly infected. There is also evidence that infection rates are rapidly increasing in rural populations. But surveillance activities remain underdeveloped rendering the fragmentary data on the prevalence, incidence and impact of HIV/AIDS highly speculative and hindering the planning and implementation of prevention and control programs. Available data on attitudes, sexual behavior and risk of infection show that while preventive measures, especially the use of condoms, have greatly increased in towns, there is still a high degree of denial and high-risk behavior and little is known about the situation in rural Ethiopia. Poverty, war, gender inequities, traditional practices, discrimination, fear, the decentralization drive and political problems have been major impediments to the prevention of infection and the care of AIDS patients. HIV/AIDS prevention efforts by the Ethiopian government are reviewed. Prospects of decentralized, multisectoral and participatory planning and implementation are briefly examined and the need to upscale the few local HIV/AIDS programs to the national level is emphasized

The relationship between resettlement and birth rates: The case of Gambella, Ethiopia

Background: This study aims to examine the possible impacts of resettlement on birth rates by using the length of stay variable in the 2000 Demographic and Health Survey (DHS).Methods: Data in all three rounds of Gambella Administrative Region’s Demographic and Health Surveys (DHS) are analyzed. The neighboring administrative region of Benishangul-Gumuz is used as a control. The multivariate analysis of variance (MANOVA) is applied with duration of residence as a categorical independent variable. The statistical software SAS is used. Results: In a univariate analysis of Gambella’s DHS 2000, duration of residence has a significant effect on mothers’ age at first birth (p < 0.001), the number of children born within the five years of the survey (p<0.001), and the total number of children ever born (P<0.001). In the MANOVA analysis, the duration effect on all three is also statistically significant (p<0.001).Discussion: Resettlement had a disruptive effect on birth rates among females who were just coming into marriageable ages in places of origin but were resettled to Gambella. Although the disruptive effects waned over time, the initial shortfall resulted in reduced overall lifetime births for settler women who were not past the midpoint of their reproductive years at arrival.Conclusion: Based on the reproductive history of female settlers with different duration of residence in the resettlement schemes, we recommend the reinstatement of the length of residence question in future DHS surveys in Ethiopia to allow a longitudinal tracking of demographic trends among nonnative populations

Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns

<p>Abstract</p> <p>Background</p> <p>In 2003, the Ethiopian Ministry of Health (MOH) started to implement a national antiretroviral treatment (ART) program. Using data in the monthly HIV/AIDS Updates issued by the MOH, this paper examines the spatial and temporal distribution of ART on a population basis for Ethiopian towns and administrative zones and regions for the period February to December 2006.</p> <p>Results</p> <p>The 101 public ART hospitals treated 44,446 patients and the 91 ART health centers treated 1,599 patients in December 2006. The number of patients currently receiving ART doubled between February and December 2006 and the number of female patients aged 15 years and older surpassed male patients, apparently due to increased awareness and provision of free ART. Of 58,405 patients who ever started ART in December 2006, 46,045 (78.8%) were adhering to treatment during that month. Population coverage of ART was highest in the three urban administrative regions of Addis Ababa, Harari and Dire Dawa, in regional centers with referral hospitals, and in several small road side towns that had former mission or other NGO-operated hospitals. Hospitals in Addis Ababa had the largest patient loads (on average 850 patients) and those in SNNPR (Southern Nations and Nationalities Peoples Republic) (212 patients) and Somali (130 patients) regions the fewest patients. In bivariate tests, number of patients receiving treatment was significantly correlated with population size of towns, urban population per zone, number of hospitals per zone, and duration of ART services in 2006 (all p < 0.001). The stronger relationship with urban than total zonal populations (p < 0.001 versus p = 0.014) and the positive correlation between distance from 44 health centers to the nearest ART hospital and patients receiving treatment at these health centers may be due to a combination of differential accessibility of ART sites, patient knowledge and health-seeking behavior.</p> <p>Conclusion</p> <p>The sharp increase in ART uptake in 2006 is largely due to the rapid increase in the provision of free treatment at more sites. The marked variation in ART utilization patterns between urban and rural communities and among zones and regions requires further studies. Recommendations are made for further expansion and sustainability of the ART scale-up.</p

INTESTINAL PARASITISM IN THREE RESETTLEMENT FARMS IN WESTERN ETHIOPIA

ABSTRACT: This paper presents results of population based surveys of intestinal parasitism among 242 settlers and 320 indigenous people in and around 3 resettlement schemes in Illubabor Administrative Region in western Ethiopia. Overall prevalence rates in settlers were 61.6% and in indigenous people 65.0%. Ascaris lumbricoides was the most common parasite in 5 of the 6 study communities, followed by hookworm, Trichuris trichiura, Entamoeba histolytica and Giardia lamblia, in that order. Only one case of schistosomiasis mansoni was found and no host snails, further indicating that its prevalence is still low in most of western Ethiopia. Differences in the prevalence of intestinal parasitism among the study communities appear to be associated with environmental sanitation, water supply and socio-economic status of households, although this needs to be verified in more extensive follow-up studies

Schistosoma mansolii infection in Jiga town, Gojam Administrative Region

Summary: The impact of socioeconomic status and water use patterns on Schistosoma mansoni infection was studied in Jiga town in Gojam Administrative Region: Questionnaire interviews and parasitological surveys were made in a 10% randomly selected household sample covering 106 households with 505 individuals. The household surveys showed that use of stream water continued after installation of the piped water system in 1983, due to the high cost of piped water and frequent breakdown of the pump. Simple and multiple regression and correlation analyses of the relationship between S.mansoni infection and socioeconomic, water use and environmental variables at the individual and household levels revealed that intensity of infection was not related to the amount of water used in the home (r=-0.33, p&lt;0.05) and income (r= -0.37, p&lt;0.05). Infection rate was positively correlated with level of education (r = 0.34), students being the most affected (r = 0.30) .Mapping of mean egg counts and water sources used failed to reveal any travel distance effect on infection. The potential use of geographic mapping of individual and household infection and behavioral data in tropical disease research is discussed.[Ethiop. J. HealthDev.1995;9(1):1-6

Exploring the contribution of indigenous medicine to primary healthcare in West Belesa District in northwestern Ethiopia: A qualitative analysis

Background: This study explores the contribution made by indigenous medicine to primary healthcare services in West Belesa Woreda (District) in northwestern Ethiopia. Objective: The study aims to examine the practices of indigenous medicine in three communities in West Belesa Woreda, the perceptions of its use and efficacy among indigenous medical practitioners and biomedical healthcare practitioners, and their views on its role in primary healthcare. Methods: Qualitative research, including in-depth interviews, focus group discussions and direct observation, using an ethnographic design, was conducted from February to April 2017. In total, 16 key informants were interviewed and six focus group discussion sessions were held. Thematic analysis was undertaken to analyze the data. Results: The local pluralistic healthcare system employs both indigenous medicine and biomedicine, often in combination. However, indigenous healing is generally the first choice due to its greater availability, affordability, and cultural acceptability. Malaria, intestinal worms, diarrhea, stomach ache, gastritis, wounds, snake bites, and epilepsy are commonly treated by herbalists with medicines prepared from plants and plant products. Illnesses that are perceived to be due to buda (evil eye) and spirit possession are mostly treated with tsebel (holy water), prayers and spirit exorcism. The findings also show that most modern healthcare providers have negative perceptions towards indigenous medicine, mainly because it lacks standards for prescribing medications. On the other hand, some beneficiaries of indigenous medicine asserted that indigenous healers provide better primary healthcare for spiritual illnesses and bone fractures. Conclusions: Understanding the cultural context of health, illness, and healing, and the involvement of indigenous healers in primary healthcare, may facilitate the provision of compatible treatments consistent with Amhara cultural and religious traditions and the integration of indigenous medicine and biomedicine. [Ethiop. J. Health Dev. 2020; 34(3):191-204] Key words: Indigenous medicine, primary healthcare, qualitative analysis, Ethiopi

Physicochemical properties of the sugar industry and ethanol distillery wastewater and their impact on the environment

The sugar industries and ethanol distilleries have been rapidly expanding globally since bioethanol emerged as a renewable bioenergy source. However, these industries generate large volumes of wastewater with high levels of organic matter, nutrients, and metal contents, which are discharged into the nearby environment without adequate treatment. This industrial pollution may have an adverse effect on aquatic and terrestrial ecosystems. Hence, this study aimed at investigating the physicochemical properties and metal constituents of sugar industry and ethanol distillery wastewater and its adverse effect on the environment. The study also assessed the legal framework of industrial wastewater management in the sugar-ethanol industry. The wastewater samples were collected from Metahara sugar factory and ethanol distillery using timecomposite sampling techniques. The laboratory analyses of physicochemical parameters and metal constituents of the wastewater were performed using standard methods. Results show that the physicochemical properties of the sugar industry's wastewater (mg/L) were pH 7.6 +/- 0.5, total solids (TS): 3050 +/- 628, 5 days biochemical oxygen demand (BOD5): 1052 +/- 560, chemical oxygen demand (COD): 1752 +/- 433.0, NO3 -N: 0.4 +/- 0.3, PO4 -3 : 3.5 +/- 1.5, SO4 -2 : 30 +/- 9.0 and Cl -: 45 +/- 10.4, whereas the ethanol distillery parameters (mg/L) were pH 3.9 +/- 0.1, TS: 150,300 +/- 9200, BOD5: 40,271 +/- 3014, COD: 132,445 +/- 6655, NO3 -N: 3.2 +/- 1.0, PO4 -3 : 21.2 +/- 2.7, SO4 -2 : 4502 +/- 69 and Cl -: 6722 +/- 873. The metal constituents of the sugar industry and ethanol distillery wastewater were, respectively: Na: 61.1-113.4, 207.6-263.0 mg/L; K: 87-161, 1143.9-2987.0 mg/L; Mg: 274.2-341.0, 816.3-927.6 mg/L; Ca: 376.9-468, 1787.4-3389.8 mg/L; Cr: 0.01-0.06, 0.8-2.3 mg/L; Cu: 0.2-0.7, 1.1-1.5 mg/L; Zn: 1.3-3.5, 1.4-2.8 mg/L; Fe: 3.2-4.3, 13.8-19.6 mg/L; Ni: not detected, 0.13-2.7 mg/L and Mn: 1-1.5, 1.5-6.6 mg/L. All except one bivariate correlation between concentrations of the metals were strong (r[ 0.5). The BOD5/COD (biodegradability index) of the sugar industry was 0.60, whereas the ethanol distillery was 0.25. Analysis of variance showed the concentrations of metals in the two industries were statistically significant (p\ 0.05). Most of the parameters in this study were beyond the maximum permissible discharging limits, possibly interfering with physicochemical and biological processes in the natural environment. Hence, for the benefits of the environmental safeguards and sustainable water use of the sector, we recommend that the two wastewaters be treated using integrated approaches through blending using the biological method

Anaerobic treatment of blended sugar industry and ethanol distillery wastewater through biphasic high rate reactor

This study aimed to investigate the physicochemical properties of sugar industry and ethanol distillery wastewater and the treatment of the blended wastewater through a two-stage anaerobic reactor. For this treatment, different initial chemical oxygen demand (COD) concentrations (5-20g/L) and hydraulic retention times (HRTs) (2-10days) were applied. The sugar industry effluent characteristics obtained in terms of organic matter (mg/L) were as follows: 5days biochemical oxygen demand (BOD5): 654.5-1,968; COD: 1,100-2,148.9; total solids (TS): 2,467-4,012mg/L; and pH: 6.93-8.43. The ethanol distillery spent wash strengths obtained were: BOD5: 27,600-42,921mg/L; COD: 126,000-167,534mg/L; TS: 140,160-170,000mg/L; and pH: 3.9-4.2. Maximum COD removal of 65% was obtained at optimum condition (initial COD concentration of 10g/L and HRT of 10days), and maximum color removal of 79% was recorded under similar treatment conditions. Hence, the performance of the two-stage anaerobic reactor for simultaneous removal of COD and color from high-strength blended wastewater is promising for scaling up in order to mitigate environmental problems of untreated effluent discharge

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2004 Update

No Abstract Available Ethiop.J.Health Dev. Vol.19(1) 2005: 65-8