Capacity of the Ethiopian primary health care system to achieve universal health coverage: a primary health care progression approach.

Comprehensive and globally comparable evidence about primary health care (PHC) capacity is needed to inform policies and decisions. We carried out a study to assess the Ethiopian PHC capacity in terms of governance, inputs, and population health and facility management domains. The PHC capacity of all the regions, city administrations and the Ministry of Health was assessed using the PHC progression model. The model has 33 measures categorized into three domains. Data were collected and synthesized from all relevant national and regional documents, datasets and key informants. A team of trained evaluation experts conducted external assessments at national and regional levels followed by an internal assessment and a validation workshop. All 33 measures were scored from 1 (lowest) to 4 (highest). The inter-rater reliability test indicated that the overall agreement between internal and external scores was 65%. We found the highest consistency in the internal assessment with a score of 0.84. The findings of this study indicated that the governance domain score was 2.8 out of 4, showing varying scores in quality management, priority setting as well as innovation and learning. The inputs domain score was 2.3 for drugs, supplies and facility infrastructure. The score for the population health and facility management domain was 2. A comparison of federal and national average scores for all measures indicated no significant difference between the two (P-value = 0.69). There are relevant PHC policies and leadership structures at the federal and regional levels. However, the capacity to effectively implement these policies and strategies at sub-national levels is sub-optimal. The challenges related to major inputs coupled with data-quality problems reduced the capacity of the PHC system at the local level. Periodic assessment of the PHC system and closely working with subnational units will potentially improve the capacity of PHC in Ethiopia.

Chronic meningitis in immunocompromised adult Ethiopians visiting Tikur Anbessa Teaching Hospital and Ye'huleshet Clinic from 2003-2004.

BACKGROUND: Chronic meningitis is inflammation of the meninges where signs and symptoms develop and last for at least four weeks without alleviation. Little is known about the current etiology and incidence of the disease in adults living in developing countries. OBJECTIVE: The objective of this study was to elucidate the most common etiologies of chronic meningitis in adult Ethiopian patients and give an aid in the empiric therapy. METHODOLOGY: A total of 53 adult patients (median age 32 years) having chronic meningitis and who were admitted at Tikur Anbessa Teaching Hospital and Ye'huleshet Clinic, Addis Ababa, Ethiopia were recruited between 2003 and 2004. Of the 53 patients, bacteriological, molecular and immunological investigations were done for 52 of the study participants to detect Cryptococcus neoformans, Mycobacterium tuberculosis, Toxoplasma gondii, Brucella and Neisseria meningitides infections. RESULTS: Forty eight of the participants were HIV positive and 15% (8/52) of the CSF were positive with Cryptococcal latex antigen detection test; in addition, M. tuberculosis DNA was detected using PCR from CSF ofpatients infew of the patients. Multiple infections were observed in studyparticipants with < 0.1 to 1 CD4 to CD8 ratio. CONCLUSION: Chronic meningitis mostly occurred in HIV infected patients, where most of the infections were attributed to Cryptococcus neoformans whereas M. tuberculosis appeared secondary.

Community attitudes towards epilepsy in a rural Ethiopian setting: a re-visit after 15 years.

INTRODUCTION: Despite being a common disorder, epilepsy is perhaps the neurological condition least well understood by the general public and most likely to be associated with a wide range of misconceptions. METHODS: A cross-sectional community-based survey was conducted in a predominantly rural area of central Ethiopia where there has been a continuous supply of anticonvulsant medications for the last 15 years. Our objective was to assess the impact of this treatment upon the attitudes of rural people towards epilepsy by comparing our findings to a community attitude survey conducted between 1986 and 1988. The method used is a cross-sectional survey. RESULTS: The belief that epilepsy is a contagious illness is significantly less prevalent compared to earlier days, 30.7% vs. 44.6% (P < 0.0001). Considering epilepsy to be a form of mental illness has increased in the current sample 40.9% vs. 1.9% (P < 0.0001). Attribution of the aetiology to supernatural factors is significantly diminished and the belief that epilepsy is hereditary has significantly increased. Modern anticonvulsant medications are more favoured in the current study 4.5% vs. 0.9% (p < 0.0001), although they remained unpopular with the majority who still prefer traditional treatment. In general, female respondents' knowledge about how to help a convulsing person, ways of preventing further epileptic attacks, and causes of epilepsy was significantly less than that of the male respondents. Rural dwellers also showed more negative attitudes with regard to marriage and working with a person suffering from epilepsy. Positive attitudinal changes in the past few years were reported by 119 (19%) of the respondents, and the changes were attributed to the availability of medication in the area and increased awareness through health education given at clinics. CONCLUSION: The results show ongoing negative attitudes towards epilepsy within the community. In addition to attempts to improve seizure control, our findings highlight the importance of ongoing educational programmes directed towards community misconceptions and negative attitudes about epilepsy.