Exploring barriers for trachomatous trichiasis surgery implementation in gamo zone, Southern Ethiopia.

BACKGROUND: Trachomatous trichiasis is the leading infectious cause of blindness worldwide. The World Health Organization recommends eyelid surgery to reduce the risk of visual impairment from trichiasis. Unfortunately, the number of cases operated has grown less than expected. An understanding of barriers is fundamental for instituting measures to increase surgical uptake. Therefore, the aim of this study was to explore barriers of TT surgery implementation. METHODS: A qualitative study design was employed in December 2019. Purposive sampling technique was used to select three districts from Gamo zone, Southern Ethiopia. We conducted 9 FGDs and 12 in-depth interviews. Data was collected by audio tape recorder in Amharic and Gamogna languages and then transcribed to English language. The recorded interviews and focus group discussions were transcribed to verbatim (written text) and thematic analysis was done manually and reported accordingly. FINDINGS: we explored a number of barriers that hindered implementation of trichiasis surgery. The recurrence of trichiasis after surgery was the main challenges faced by operated individuals. The other barriers reported are negative perception towards trichiasis surgery, lack of logistic and supplies, transportation access problem for remote communities, inadequate trained health professional, less commitment from higher officials, lack of interest of integrated eye care workers due to incentive issues, believes of patients waiting supernatural power for healing service and carelessness of patients to undertake operation. CONCLUSION AND RECOMMENDATION: Post-surgical trichiasis, lack of commitment from government officials and negative perception of patients towards the disease were considered as the reported barriers for implementation of trachomatous trichiasis. Closely supervising the integrated eye care workers would be the first task for district health offices to increase the uptake and improve the quality of service. Logistics and supplies should be made available and adequate to address all affected people in the community.

Foot care practice and associated factors among patients with lymphoedema in Boreda district, Gamo zone, southern Ethiopia, 2020. Implications for elimination of podoconiosis and lymphatic filariasis.

BACKGROUND: Lymphatic filariasis is ranked as the second leading cause of disability world-wide. The current global programme to eliminate lymphatic filariasis is based on the interruption of transmission and the alleviation of disability and suffering. OBJECTIVE: to assess foot care practice and associated factors among lymphoedema patients in Boreda district, Gamo zone Southern Ethiopia. METHODS: a community based cross sectional study was employed from December 2020 to June 2021 in Boreda district. Simple random sampling technique was used for selecting participants. Pretested structured interviewer administered questionnaire was prepared in English and translated to local language. FINDINGS: a total of 280 lymphedema patients were involved in this study. More than half 153 (54.6%) had poor practice towards foot care practice with 95% CI (48.7, 60.4%). Patients who fetched 50 l of water or below and wore shoes at the age above 20 years were negatively associated with foot care practice, (AOR = 0.383, 95%CI: 0.155, 0.945) and (AOR = 0.261, 95%CI: 0.107, 0.63), respectively. Patients who owned only one pair and two pairs were negatively associated with foot care practice (AOR = 0.04, 95%CI: 0.009, 0.182) and (AOR = 0.27, 95%CI: 0.087, 0.85), respectively. On the other hand, attending LMMDP service and frequency of adenolymphangitis once and twice or more per month were positively associated with foot care practice (AOR = 3.339, 95%CI: 1.53, 7.285) and (AOR = 8.15, 95% CI: 3.157, 21.058) and (AOR = 9.35, 95% CI: 3.118, 28.059), respectively. CONCLUSION: this study indicated foot care practice among lymphedema patients in Boreda district was poor. Number of litre of water collected per day, age at which footwear first worn, number of shoes owned, attending LMMDP and frequency of adenolymphangitis were significantly associated with foot care practice. Standard foot care practice should be emphasized to control progression of lymphedema. Foot care practices like skin care, exercise and elevation, washing legs, bandaging and massaging are important factors that influence in reduction of lymphedema volume and acute attacks among people who are suffering from the diseases.

Evaluating Equity and Coverage in Mass Drug Administration for Soil-Transmitted Helminth Infections among School-Age Children in the Hard-to-Reach Setting of Southern Ethiopia.

BACKGROUND: Soil-transmitted helminth (STH) infections are prevalent in most developing countries, including Ethiopia, with school-age children (SAC) at high risk of infection. In Ethiopia, despite substantial progress being made on mass drug administration (MDA) coverage for STH infections, its implementation is facing challenges in hard-to-reach areas. This study thus aimed at assessing equity and coverage in MDA and identifying factors associated with drug coverage for STH infections among SAC in the hard-to-reach setting of southern Ethiopia. METHODS: A community-based cross-sectional survey was conducted in the North Ari district, South Omo Zone in July 2019. Sample size was estimated following WHO drug-coverage evaluation guidelines. Factors associated with drug uptake for STH infections were identified using multivariate logistic regression. RESULTS: Of 956 SAC participating in this study, the overall MDA coverage for STH was found to be 27.5% (95% CI 24.7%-30.5%). The odds of having taken drugs were highest among school-enrolled children and in those who knew the purpose of MDA: about about double their counterparts. In contrast, the odds of drug uptake were lower by 69% among those who had got informed only when the drugs delivered and by 92% among those who needed to travel >30 minutes to reach drug-distribution points than their counterparts. CONCLUSION: Achieving effective and equitable MDA coverage is facing serious challenges in the hard-to-reach setting of southern Ethiopia. The very low (27.5%) and inequitable MDA coverage found in this study are associated with school nonenrollment, inaccessibility, and lack of information, awareness, and mobilization. Social mobilization should be scaled up to inform and create awareness in the community ahead of MDA. Further, school-based deworming in settings with low school enrollment needs a modified strategy to reach those in need of drugs.

Knowledge, Attitude, Practices and Associated Factors Towards Trachoma Among People Living in Arba Minch Zuria District, Gamo Zone, Southern Ethiopia.

BACKGROUND: Trachoma is the second leading cause of blindness in the world affecting the poorest communities. Despite many interventions undertaken on prevention and control for trachoma, Ethiopia has failed to achieve the 2020 elimination goal. OBJECTIVE: To assess knowledge, attitude, practice and its associated factors toward trachoma infection among people living in Arba Minch Zuria district Gamo zone, Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from December 2019 to June 2020. Data were collected using a pretested interviewer-administered questionnaire from 796 randomly selected individuals. Epi Info version 7 was used to enter and clean the data and exported to SPSS V20 for analysis. A multivariable logistic regression analysis model was fitted to identify factors associated with the outcome variables. FINDINGS: Among 796 interviewed participants, 611 (76.8%) had inadequate knowledge toward trachoma infection and 244 (30.7%) had unfavorable attitude. Individuals who had no formal education (AOR=0.365, 95%CI: 0.212-0.626) and primary education (AOR=0.58, 95%CI: 0.35-0.962) were negatively associated with adequate knowledge towards trachoma infection. Being a farmer (AOR=0.063, 95%CI: 0.008-0.52), merchant (AOR=0.022, 95%CI: 0.003-0.194), student (AOR=0.026, 95%CI: 0.003-0.225) or housewife (AOR=0.03, 95%CI: 0.004-0.256) were negatively associated with adequate knowledge. Those study subjects whose wealth index were lowest (AOR=0.49, 95%CI: 0.27-0.878), second (AOR=0.38, 95%CI: 0.21-0.69) and middle (AOR=0.36, 95%CI: 0.199-0.658) percentiles negatively associated with adequate knowledge. A short distance to fetch water (AOR=2.53, 95%CI: 1.18-5.415) was positively associated with adequate knowledge about trachoma infection. Environmental cleanliness (AOR=2.224, 95%CI: 1.518-3.257), being male (AOR=1.848, 95%CI: 1.332-2.565) and distance from home to health facility (AOR=1.845, 95%CI: 1.308-2.600) were significantly associated with attitude status. CONCLUSION: Considerable numbers of people have unfavorable attitude and inadequate knowledge about trachoma infection. Awareness creation through community mobilization and sensitization should be strengthened.

Knowledge, attitude, practice and associated factors of health professionals towards podoconiosis in Gamo zone, Ethiopia, 2019.

BACKGROUND: Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. The prevalence of podoconiosis in Ethiopia was 7.45%. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. METHODS: Facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. RESULT: A total of 320 health professionals participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) identified podoconiosis as infectious disease. Profession, address of health facility, service year and attitude of participants were significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value = 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents treated podoconiosis patients. Age group 45 years old and above and training on lymphedema morbidity management and disability prevention were significantly associated with clinical experience in treating affected patients, (AOR = 17.345; 95%CI: 4.62, 65.119) and (AOR = 7.385; 95%CI: 2.5, 21.797), respectively. CONCLUSION: Despite, high percent of good knowledge of health professionals towards podoconiosis, clinical experience of health professionals in treating podoconiosis patients was very low. In-service trainings will be given for health professionals to improve treatment. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.

Coverage Validation Survey for Lymphatic Filariasis Treatment in Itang Special District of Gambella Regional State of Ethiopia: A Cross-Sectional Study.

BACKGROUND: Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia. In order to alleviate this problem Mass drug administration (MDA) has been given once a year for the public living in endemic sites. Despite this fact there might be a difference between reported coverage and the actual coverage on the ground due to various errors, so assessing the actual coverage through coverage validation survey appears imperative. OBJECTIVE: The aim of this survey was to assess the difference between the reported coverage and actual coverage of Ivermectin (IVM) and Albendazole (ALB) treatment given for Lymphatic Filariasis in Itang special district of Gambella regional state, Ethiopia. SETTING: The study was conducted in Itang special district of Gambella region, the district was purposively selected for lymphatic filariasis treatment coverage survey. Eligible individuals aged 5 and above were interviewed. Data about the children were collected from parents or guardians and analyzed using STATA. RESULTS: The survey showed that the coverage for LF treatment was 81.5%. From 825 individuals that reported that they were offered the treatment 823 (99.6%) swallowed the drug. The coverage in school age children (5-14) shows significant difference with treatment coverage in individuals aged 15 and above (p<0.001) in the last mass drug administration campaign. The main reason for not being offered preventive chemotherapy (PC) during the mass drug administration campaigns was missing class during the MDA (37.2%). CONCLUSION: The treatment coverage is higher than the recommended coverage of 65% of the target population. The coverage in school age children (5-14) showed significant difference with treatment coverage in individuals aged 15 and above. Improving the coverage level beyond this can significantly contribute to the LF elimination goal.

Ivermectin Treatment Coverage Validation in Two Onchocerciasis Endemic Districts in Ethiopia: A Community-Based Cross-Sectional Study, 2019.

BACKGROUND: Onchocerciasis is the second leading cause of blindness globally next to trachoma, thus eliminating the infection is an important health priority. It is estimated that 15.7 million people are at risk of infection in different parts of Ethiopia. Mass drug administration with ivermectin at community and school level is the basis for control and elimination of onchocerciasis. This study was aimed at validating onchocerciasis treatment coverage in the selected districts of Ethiopia. METHODS: A community-based cross-sectional study was employed in Itang special and Wombera districts of Ethiopia, from April 1 to 30, 2019 G.C. We used a coverage validation survey builder tool to compute sample size. Individuals aged five years old and above were eligible population. Data were entered into Microsoft Excel and exported to STATA 14 for cleaning and analyses. A chi-square test was used to note statistical association of the outcome variables with independent variables. MAIN FINDINGS: A total of 3765 individuals were interviewed. Of these, 3244 were offered onchocerciasis treatment. The overall treatment coverage of onchocerciasis in the two selected districts of Ethiopia was 85.9% of the eligible population (3235/3765) (95% CI, 84.8%, 87%). There was significant difference between the two districts in terms of ivermectin offering (X2=70.467, P<0.001). School attendance was also significantly associated with treatment offering and swallowing status (X2=77.29, P<0.001; and X2=30.581, P<0.001). The main reported reasons for not being offered ivermectin were "being absent" (40.86%) and "not knowing about the mass drug administration" (MDA) (25.29%). CONCLUSION: In conclusion, the treatment coverage of onchocerciasis in this survey was higher than minimum national desired therapeutic coverage. Treatment coverage in Wombera was higher than Itang special district. In addition, children who attended school had a higher chance of swallowing the drug.

Determinants of soil-transmitted helminth infections among pre-school-aged children in Gamo Gofa zone, Southern Ethiopia: A case-control study.

BACKGROUND: Pre-school aged children (PSAC) are highly affected by soil-transmitted helminths (STH), particularly in areas where water, sanitation, and hygiene (WASH) are inadequate. Context-specific evidence on determinants of STH infections in PSAC has not been well established in the study area. This study, therefore, aimed to fill these gaps in Gamo Gofa zone, Southern Ethiopia. METHODS: A community-based unmatched case-control study, nested in a cross-sectional survey, was conducted in January 2019. Cases and controls were identified based on any STH infection status using the Kato-Katz technique in stool sample examination. Data on social, demographic, economic, behavioral, and WASH related variables were collected from primary caregivers of children using pre-tested questionnaire. Determinants of STH infections were identified using multivariable logistic regression model using SPSS version 25. RESULTS: A total of 1206 PSAC (402 cases and 804 controls) participated in this study. Our study showed that the odds of STH infection were lowest among PSAC living in urban areas (AOR = 0.55, 95% CI: 0.39-0.79), among those from households with safe water source (AOR = 0.67, 95% CI: 0.47-0.0.93), and in those PSAC from households with shorter distance from water source (<30 minutes) (AOR = 0.51, 95% CI: 0.39-0.67). On the other hand, the odds of STH infection were highest among PSAC from households that had no functional hand washing facility (AOR = 1.36, 95% CI: 1.04-1.77), in those PSAC from households that had unclean latrine (AOR: 1.82, 95% CI: 1.19-2.78), and among those PSAC under caregivers who had lower score (≤5) on knowledge related to STH transmission (AOR = 1.85, 95% CI: 1.13-3.01). CONCLUSIONS: Given efforts required eliminating STH by 2030; the existing preventive chemotherapy intervention should be substantially strengthened with WASH and behavioral interventions. Thus, an urgent call for action is required to integrate context-specific interventions, particularly in rural areas.

Soil-transmitted helminth infections among pre-school aged children in Gamo Gofa zone, Southern Ethiopia: Prevalence, intensity and intervention status.

BACKGROUND: Soil-transmitted helminths (STH), i.e., Ascaris lumbricoides, Trichuris trichiura and hookworms are among the most prevalent Neglected Tropical Diseases (NTDs) in Ethiopia. Although pre-school aged children pay a high morbidity toll associated with STH infections, evidence on prevalence, intensity and intervention status is lacking in Ethiopia. This study, therefore, aimed to address these gaps to inform decision made on STH. METHODS: We did a community-based cross-sectional study in five districts of Gamo Gofa zone, Southern Ethiopia; in January 2019. Data were collected using pre-tested questionnaire, and the Kato-Katz technique was used to diagnose parasites eggs in stool. Then, collected data were edited and entered into EpiData 4.4.2, and exported to SPSS software (IBM, version 25) for analysis. RESULTS: A total of 2462 PSAC participated in this study. Overall, the prevalence of STH was 23.5% (578/2462) (95% confidence interval (CI) = 21.8%-25.2%). As caris lumbricoides was the most prevalent (18.6%), followed by Trichuris trichiura (9.2%), and hookworms (3.1%). Of the total, 7.4% PSAC were infected with two STH species. Most of the positive cases with STH showed low infection intensities, while 15.1% ascariasis cases showed moderate infection intensities. The study found that 68.7% of PSAC were treated with albendazole. Also, household's level data showed that 39.4% used water from hand-dug well; 52.5% need to travel ≥30 minutes to collect water; 77.5% did not treat water, and 48.9% had no hand washing facility. In addition, almost 93% care givers achieved less than the mean knowledge and practice score (≤5) on STH prevention. CONCLUSIONS: This study showed that significant proportions of pre-school aged children are suffering from STH infections despite preventive chemotherapy exist at the study area. Also, gaps in the interventions against STH were highlighted. Thus, a call for action is demanding to eliminate STH among PSAC in Ethiopia by 2030.

Towards the trachoma elimination target in the Southern region of Ethiopia: How well is the SAFE strategy being implemented?

INTRODUCTION: Trachoma is one of the 20 neglected tropical diseases and a serious public health problem in Ethiopia. To reach the WHO elimination target by 2020, SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy has been implemented in the Southern Nations, Nationalities, and Peoples' Region (SNNPRs), Ethiopia. Scarce evidence exists regarding recent progress in achieving elimination of active trachoma (< 5%) and how well the SAFE strategy implemented. METHODOLOGY: A retrospective analysis of programmatic data in the period 2013-2018 was used. All trachoma endemic districts in SNNPR were included. Data collected from the Federal Ministry of Health on trachoma prevalence and SAFE strategy were analyzed. RESULTS: Out of 134 endemic districts, only 35 had their planned impact survey, of which only 11 districts achieved the elimination target. Six districts reverted backwards from eliminated status to low (1) or moderate (5) level. The median prevalence of active trachoma in these 35 districts was 10% in 2017/18. In 2017, the mean antibiotic treatment coverage was 90%, but only 56% and 68% of districts implemented and reported on "F" and "E" components, respectively. In the high prevalence districts, only 10% delivered their planned five rounds of Zithromax® mass distribution. CONCLUSIONS: These data showed a lack in planned impact surveys with only a limited number of districts reached the WHO elimination threshold by 2018. Lack of attention on high prevalent districts, and recent reversal of trachoma eliminated districts to moderate or low prevalence levels argue for urgent and prioritized implementation of the SAFE strategy.

Preventive chemotherapy coverage against soil-transmitted helminth infection among school age children: Implications from coverage validation survey in Ethiopia, 2019.

BACKGROUND: Soil-transmitted helminth (STH) infections remain the most common neglected tropical diseases among children living mainly in low-resource settings. Preventive chemotherapy (PC) has been implemented as one of the main public health interventions to control and eliminate STH infections. Although data on routine coverage of PC against STH are available at different level of the health system; these data are unreliable as they are subject to errors and manipulation and evidence is lacking on validated treatment coverage. Thus, this study aimed to determine anthelminthic coverage among school age children (SAC) to inform decision made in PC program implementation. METHODS: We conducted a community-based cross-sectional coverage survey in ten districts of Ethiopia; in April 2019. Sample size was computed automatically using Coverage Survey Builder (CSB) tool in Microsoft excel. Thirty segments were randomly selected per each selected districts. Collected data were cleaned and analysed using SPSS software (IBM, version 25). PRINCIPAL FINDINGS: In all, 8154 SAC participated in the study. The overall anthelminthic coverage was found to be 71% (95%confidence interval (CI) = 70-71.9%). The reported coverage was lower than the surveyed coverage only in Guagusa district. The PC coverage among males (71.9%) was slightly higher than females' coverage (70%); and the coverage in the age group between10 and 14 years (77%) was higher compared with the age group between 5 and 9 years (64.3%). In addition, the PC coverage in school attending children (81.1%) was much higher than coverage in non-enrolled children (28.3%). Moreover, the most frequently mentioned reasons for not swallowing drugs were drug not given (24.75%) and not attending school (19.75%). CONCUSSION: This study showed that only five out of ten districts met the target threshold (minimum 75%) for effective coverage. Hence, implementations of preventive chemotherapy should be improved in those districts with low coverage data.

Prevalence of hepatitis B virus, its risk factors and co-infection with human immune deficiency virus among clients of voluntary counseling and testing center in Hosanna, Southern Ethiopia

Hepatitis B infection (HBV) infection is a serious public health problem worldwide and its co-infection with human immune deficiency virus (HIV) is common due to shared routes of transmission. An increased mortality due to accelerated hepatic disease progression and the frequent hepatotoxicity caused by antiretroviral therapy are the challenges in the clinical management of HIV. Epidemiological studies on HBV and HBV/HIV co infection are scarce in Ethiopia, particularly at the study area. The aim of this study was to determine the magnitude of HBV, its risk factors and co-infection with HIV among clients of a voluntary counseling and testing (VCT) center in Southern Ethiopia. A facility based crosssectional study was conducted from 1st February 2016 to 15th March among clients of Nigist Eleni Memorial Hospital VCT Center. Data were collected by face-to-face interview and specific formula sheet as well recorded results of laboratory diagnosis of blood sample from each participant. Both descriptive and inferential statistics were used for data analysis. Multivariable logistic regression modeling was done to identify predictors of HBV. Overall, 331 participants were included in the study. The prevalence of HBV was 8.8%, HBV/HIV co-infection was found in 3.6%. Individuals with a history of multiple sexual partner [AOR = 10.3; 95% CI, 3.71 - 28.83], previous history of invasive procedure [adjusted odds ratio (AOR) = 10.88; 95% CI, 3.84 - 30.86] and history of surgical procedure [AOR = 9.2; 95% CI, 3.1 - 27.88] were identified as in dependent predictors of HBV infection. High HBV infection and HBV/HIV coinfection was found in the study.Previous history of surgical procedure, invasive procedure and multiple sexual partners were identified as independent predictor of HBV infection