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1.
Reprod Health ; 19(1): 2, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983586

RESUMO

BACKGROUND: Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country's first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. METHODS: This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women's and providers' perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. RESULTS: Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. CONCLUSIONS: In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.


Assuntos
Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Etiópia , Feminino , Grupos Focais , Humanos , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
2.
BMC Health Serv Res ; 22(1): 43, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-34998413

RESUMO

BACKGROUND: Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). METHODS: AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50-74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time. RESULTS: After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23-46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03-77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01-33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38-65.6%] in September 2019. CONCLUSIONS: Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Gerenciamento de Dados , Etiópia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Instalações de Saúde , Humanos , Instalações Privadas
3.
BMJ Open ; 12(1): e056009, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980628

RESUMO

OBJECTIVES: This study aims to identify levels of adherence to antiretroviral therapy (ART) drugs and factors associated with them in Northwest Ethiopia. We hypothesise that in the era of COVID-19, there would be suboptimal adherence to ART drugs. DESIGN: An observational cross-sectional study was conducted. Factors associated with the level of adherence were selected for multiple logistic regressions at a p value of less than 0.2 in the analysis. Statistically significant associated factors were identified at a p value less than 0.05 and adjusted OR with a 95% CI. SETTING: The study was conducted in one specialised hospital and three district hospitals found in the South Gondar zone, Northwest Ethiopia. PARTICIPANTS: About 432 people living with HIV/AIDS receiving highly active ART in South Gondar zone public hospitals and who have been on treatment for more than a 3-month period participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Levels of adherence to ART drugs and their associated factors. RESULTS: Among 432 study participants, 81.5% (95% CI: 78% to 85.2%) of participants were optimally adherent to ART drugs. Determinants of a low level of adherence: stigma or discrimination (OR=0.4, p=0.016), missed scheduled clinical visit (OR=0.45, p=0.034), being on tuberculosis treatment (OR=0.45, p=0.01), recent CD4 cell count less than 500 cells/mm3 (OR=0.3, p=0.023) and patients who had been on WHO clinical stage III at the time of ART initiation (OR=0.24, p=0.027) were factors significantly associated with adherence to ART drugs. CONCLUSIONS: Level of adherence was relatively low compared with some local studies. The intervention targeted to reduce discrimination, counselling before initiation of treatment and awareness regarding compliance is advised to improve adherence to antiretroviral regimens.


Assuntos
COVID-19 , Infecções por HIV , Estudos Transversais , Etiópia , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação , SARS-CoV-2
4.
Environ Res ; 204(Pt A): 112033, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34509478

RESUMO

Due to their global distribution, persistence, bioaccumulative potential and toxicity, perfluoroalkyl substances (PFASs) are considered as hazardous chemicals. Although many studies on PFASs pollution in aquatic environments have been done in the Northern hemisphere, less is known on PFASs pollution in African aquatic ecosystems and the risks they pose to humans through consumption of contaminated biota. The objective of this study was to determine the spatial distribution of PFASs in water, sediment, and fish tissue in Lake Hawassa, Ethiopia, and to investigate possible human health risks due to fish consumption. Among the PFASs detected in water and sediment, perfluorooctanoic acid (PFOA) was the most abundant with mean concentrations of 6.93 ng/L and 0.23 ng/g dw respectively. Long-chained PFASs dominated the PFAS accumulation profiles in fish tissues, with higher concentrations measured in liver compared to muscle tissue. The detected concentrations of PFASs were, however, often similar to those reported in other African aquatic ecosystems. This study showed no potential health risk due to consumption of contaminated fish based on mean concentrations and fish consumption. However, it is expected that peoples who consume more fish (fishermen and local peoples living close to Lake Hawassa) may suffer health risks due to PFASs contamination.


Assuntos
Ácidos Alcanossulfônicos , Fluorcarbonetos , Poluentes Químicos da Água , Ácidos Alcanossulfônicos/análise , Animais , China , Ecossistema , Monitoramento Ambiental , Etiópia , Fluorcarbonetos/análise , Fluorcarbonetos/toxicidade , Humanos , Lagos , Água , Poluentes Químicos da Água/análise
5.
Lancet Glob Health ; 10(1): e87-e95, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34919861

RESUMO

BACKGROUND: WHO promotes the SAFE strategy for the elimination of trachoma as a public health programme, which promotes surgery for trichiasis (ie, the S component), antibiotics to clear the ocular strains of chlamydia that cause trachoma (the A component), facial cleanliness to prevent transmission of secretions (the F component), and environmental improvements to provide water for washing and sanitation facilities (the E component). However, little evidence is available from randomised trials to support the efficacy of interventions targeting the F and E components of the strategy. We aimed to determine whether an integrated water, sanitation, and hygiene (WASH) intervention prevents the transmission of trachoma. METHODS: The WASH Upgrades for Health in Amhara (WUHA) was a two-arm, parallel-group, cluster-randomised trial in 40 rural communities in Wag Hemra Zone (Amhara Region, Ethiopia) that had been treated with 7 years of annual mass azithromycin distributions. The randomisation unit was the school catchment area. All households within a 1·5 km radius of a potential water point within the catchment area (as determined by the investigators) were eligible for inclusion. Clusters were randomly assigned (at a 1:1 ratio) to receive a WASH intervention either immediately (intervention) or delayed until the conclusion of the trial (control), in the absence of concurrent antibiotic distributions. Given the nature of the intervention, participants and field workers could not be masked, but laboratory personnel were masked to treatment allocation. The WASH intervention consisted of both hygiene infrastructure improvements (namely, construction of a community water point) and hygiene promotion by government, school, and community leaders, which were implemented at the household, school, and community levels. Hygiene promotion focused on two simple messages: to use soap and water to wash your or your child's face, and to always use a latrine for defecation. The primary outcome was the cluster-level prevalence of ocular chlamydia, measured annually using conjunctival swabs in a random sample of children aged 0-5 years from each cluster at 12, 24, and 36 month timepoints. Analyses were done in an intention-to-treat manner. This trial is ongoing and is registered at ClinicalTrials.gov, NCT02754583. FINDINGS: Between Nov 9, 2015, and March 5, 2019, 40 of 44 clusters assessed for eligibility were enrolled and randomly allocated to the trial groups (20 clusters each, with 7636 people from 1751 households in the intervention group and 9821 people from 2211 households in the control group at baseline). At baseline, ocular chlamydia prevalence among children aged 0-5 years was 11% (95% CI 6 to 16) in the WASH group and 11% (5 to 18) in the control group. At month 36, ocular chlamydia prevalence had increased in both groups, to 32% (24 to 41) in the WASH group and 31% (21 to 41) in the control group (risk difference across three annual monitoring visits, after adjustment for prevalence at baseline: 3·7 percentage points; 95% CI -4·9 to 12·4; p=0·40). No adverse events were reported in either group. INTERPRETATION: An integrated WASH intervention addressing the F and E components of the SAFE strategy did not prevent an increase in prevalence of ocular chlamydia following cessation of antibiotics in an area with hyperendemic trachoma. The impact of WASH in the presence of annual mass azithromycin distributions is currently being studied in a follow-up trial of the 40 study clusters. Continued antibiotic distributions will probably be important in areas with persistent trachoma. FUNDING: National Institutes of Health-National Eye Institute. TRANSLATION: For the Amharic translation of the abstract see Supplementary Materials section.


Assuntos
Higiene/normas , Saneamento/métodos , Tracoma/epidemiologia , Tracoma/prevenção & controle , Abastecimento de Água/normas , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Tracoma/tratamento farmacológico
6.
Lancet Psychiatry ; 9(1): 59-71, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34921796

RESUMO

BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.


Assuntos
Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Análise Custo-Benefício , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , População Rural , Método Simples-Cego , Organização Mundial da Saúde
7.
J Environ Manage ; 302(Pt A): 113973, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34688050

RESUMO

This study used a contingent valuation method to estimate residents' WTP for improved solid waste management in Hawassa city. The improvement in solid waste management includes the relocation of the current landfill and the switch from open donkey carts to covered tractors with a waste compactor for solid waste transportation. A method of iterative bidding was used to ask residents about their WTP, and ordinal logistic regression was used for data analysis. The result of the study indicated that the estimated average WTP of residents was Ethiopian Birr (ETB) 26.57 ($ 0.62) per month. Besides, the study findings showed that waste minimization practices such as reuse, recycle, waste separation and making compost from waste were uncommon at the household level in Hawassa city. The policy implications of the findings are that the Municipality of Hawassa should consider the residents' willingness for improved solid waste management service and adopt the solid waste management improvement project to prevent further public health risks and environmental impacts.


Assuntos
Resíduos Sólidos , Gerenciamento de Resíduos , Cidades , Etiópia , Reciclagem
8.
Sci Total Environ ; 806(Pt 1): 150443, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34844310

RESUMO

Understanding the suitability of Satellite Rainfall Estimates (SREs) in simulating high flows and Actual Evapotranspiration (AET) is crucial for developing flood monitoring systems. Therefore, this study aims to assess i) the suitability of SREs in simulating both high flows and AET for different levels of model complexity, and ii) the effect of streamflow calibration on simulating AET for different rainfall inputs in Melkakunitre catchment, Upper Awash Basin, Ethiopia. Three state-of-the-art SREs (TRMM 3B42v7, IMERG v06B, and TAMSAT v3) were used and their usefulness in simulating high flows (Q5), daily streamflow, and wet season flows (from June to September) was assessed using the HBV-light model for the period 2003-2015. The model was set up for two levels of complexity: with and without considering the effect of orography on rainfall and temperature. Moreover, the water balance derived AET was compared against three remotely sensed AET products, MOD 16A2, GLEAM v3, and SSEBob, so as to examine the effect of streamflow calibration on AET simulation. Results show that rainfall inputs and model complexity have a strong impact on simulating streamflow and AET. For all rainfall forcing datasets, the performance of the hydrological model improves when we consider the effects of orography on rainfall and temperature. The IMERG v06B and TAMSAT v3 products showed the highest and least performances in simulating all the three flow conditions, respectively. Moreover, the MODIS-AET is the best remotely sensed AET product in reproducing the water balance-derived AET for all rainfall inputs except TAMSAT v3. The HBV-light model parameters calibrated with streamflow provided better results for simulating AET as well. On average, the usefulness of the IMERG v06B product for simulating high flows and AET is outstanding and can be thus used for developing flood monitoring and management systems in the study catchment.


Assuntos
Inundações , Hidrologia , Etiópia , Temperatura
9.
Pan Afr Med J ; 40: 170, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34970412

RESUMO

Introduction: tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students. Methods: a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association. Results: the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking. Conclusion: the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.


Assuntos
Fumar Cigarros , Adolescente , Estudos Transversais , Etiópia/epidemiologia , Humanos , Masculino , Prevalência , Fumaça , Estudantes , Inquéritos e Questionários , Tabaco
10.
Malar J ; 20(1): 466, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906139

RESUMO

BACKGROUND: The emergence and spread of resistant strains of malaria vectors to chemical insecticides are becoming major problems for malaria vector management. Natural plant products have a vital role to play in the current challenge of malaria control. The current study was conducted to evaluate insecticidal effect of ethnobotanical plant extracts against the primary malaria vector, Anopheles arabiensis in northwestern Ethiopia. METHODS: Primarily, ethnobotanical plants used for Anopheles mosquito control were surveyed in Dangur district, northwestern Ethiopia. Insecticide-susceptible strains of Anopheles arabiensis mosquito were reared in the insectary of the Tropical and Infectious Diseases Research Centre, Assosa University. After surveying plants used for mosquito control in local people, four frequently used plants were identified for extraction. The larvicidal and adulticidal potential of frequently used plant extracts against susceptible strains of the laboratory colony were evaluated. RESULTS: A total of 15 plants were identified as ethnobotanical plants that help local people with mosquito control. Azadirachta indica, Ocimum lamiifolium, Ocimum americanum, Moringa olifeira leaf, and Moringa olifeira seed species of local plants were found to be frequently used to kill and/or repel mosquitoes in the study district. All the plant extracts were found to have potential larvicidal activity against fourth instar larvae of An. arabiensis and only ethanol and methanol extract of Azadirachta indica and Ocimum lamiifolium were found to have potential adulticidal effect against adult of An. arabiensis. The highest larvicidal activity was observed in ethanol extract of Azadirachta indica with 95% larval mortality and lowest Lethal Concentration 50 (LC 50) of 40.73parts per million (ppm) and LC90 of 186.66 ppm. The highest adulticidal activity was observed in methanol extract of Azadirachta indica with 75% adult mortality at 300 ppm and lowest LC50 of 106.65 ppm and LC90 of 1,293 ppm. The lowest larvicidal and adulticidal activity was observed in methanol extracts of Ocimum lamiifolium with 63.35% larval mortality and leaf extract of Moringa olifeira with 50% adult mortality at 300 ppm, respectively. CONCLUSION: Ethanol extract of Azadirachta indica exerted a remarkable larvicidal effect against An. arabiensis and thus it can be used for botanical mosquito insecticide development. Since the current finding is based on susceptible strain of An. arabiensis, further work on wild mosquitoes is recommended.


Assuntos
Anopheles , Inseticidas , Controle de Mosquitos , Mosquitos Vetores , Extratos Vegetais , Animais , Etiópia , Etnobotânica
11.
Malar J ; 20(1): 468, 2021 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922543

RESUMO

BACKGROUND: In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Different household-level factors have been identified as associated with LLIN use. However, the contribution of LLIN physical integrity to their utilization is not well investigated and documented. This study aimed to assess the association between the physical integrity of LLINs and their use. METHODS: This study employed a nested case-control design using secondary data from the Ethiopian LLIN durability monitoring study conducted from May 2015 to June 2018. LLINs not used the night before the survey were identified as cases, while those used the previous night were categorized as controls. The physical integrity of LLINs was classified as no holes, good, acceptable, and torn using the proportionate hole index (pHI). A Generalized Estimating Equation (GEE) model was used to assess and quantify the association between LLIN physical integrity and use. The model specifications included binomial probabilistic distribution, logit link, exchangeable correlation matrix structure, and robust standard errors. The factors included in the model were selected first by fitting binary regression, and then by including all factors that showed statistical significance at P-value less than 0.25 and conceptually relevant variables into the multivariate regression model. RESULTS: A total of 5277 observations fulfilled the inclusion criteria. Out of these 1767 observations were cases while the remaining 3510 were controls. LLINs that were in torn physical condition had higher odds (AOR [95% CI] = 1.76 [1.41, 2.19]) of not being used compared to LLINs with no holes. Other factors that showed significant association included the age of the LLIN, sleeping place type, washing status of LLINs, perceptions towards net care and repair, LLIN to people ratio, economic status, and study site. CONCLUSION AND RECOMMENDATION: LLINs that have some level of physical damage have a relatively higher likelihood of not being used. Community members need to be educated about proper care and prevention of LLIN damage to delay the development of holes as long as possible and use available LLINs regularly.


Assuntos
Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/prevenção & controle , Controle de Mosquitos/estatística & dados numéricos , Estudos de Casos e Controles , Etiópia , Características da Família
12.
Int J Mycobacteriol ; 10(4): 364-372, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34916453

RESUMO

Background: One-third of tuberculosis (TB) cases are missed each year and delays in the diagnosis of TB are hampering the whole cascade of care. Early chest X-ray (CXR) in patients with cough irrespective of duration may reduce TB diagnostic and treatment delays and increase the number of TB patients put into TB care. We aimed to evaluate the impact of CXR on delay in the diagnosis of pulmonary tuberculosis (PTB) among people with cough of any duration. Methods: A facility-based cross-sectional study was conducted in four selected health facilities from two regions and two city administrations of Ethiopia. Patients who sought health care were screened for cough of any duration, and those with cough underwent CXR for PTB and their sputum specimens were tested for microbiological confirmation. Delays were followed up and calculated using median and inter-quartile range (IQR) to summarize (first onset of cough to first facility visit, ≥15 days), diagnosis delay (first facility visit to date of PTB diagnosis, >7 days), and total delay (first onset of cough to date of PTB diagnosis, >21 days). Kruskal-Wallis and Mann-Witney tests were used to compare the delays among independent variables. Results: A total of 309 PTB cases were consecutively diagnosed of 1853 presumptive TB cases recruited in the study that were identified from 2647 people who reported cough of any duration. The median (IQR) of patient delay, diagnosis delay, and the total delay was 30 (16-44), 1 (0-3), and 31 (19-48) days, respectively. Patients' delay contributed a great role in the total delay, 201/209 (96.2%). Median diagnosis delay was higher among those that visited health center, diagnosed at a facility that had no Xpert mycobacterium tuberculosis (MTB)/RIF assay, radiologist, or CXR (P < 0.05). Factors associated with patients delay were history of previous TB treatment (adjusted prevalence ratio [aPR] = 0.79, 95% confidence interval [CI]: 0.63-0.99) and history of weight loss (aPR = 1.12; 95% CI: 1.0-1.25). Early CXR screening for cough of <2 weeks duration significantly reduced the patients' delay and thus the total delay, but not diagnostic delay alone. Conclusion: Early screening using CXR minimized delays in the diagnosis of PTB among people with cough of any duration. Patients' delay was largest and contributed great role in the delay of TB cases. Screening by cough of any duration and/or CXR among people seeking healthcare along with ensuring the availability of Xpert MTB/RIF assay and skilled human power at primary healthcare facilities are important to reduce patient and diagnostic delays of PTB in Ethiopia.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Estudos Transversais , Etiópia/epidemiologia , Humanos , Radiografia , Escarro , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia
13.
Int J Mycobacteriol ; 10(4): 437-441, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34916465

RESUMO

Background: Tuberculosis (TB) remains a major cause of morbidity and mortality in Ethiopia despite the increased availability of effective treatments. Trend analysis of issues and priorities affecting TB programs across different regions of the country is critical to ensure equitable and sustainable TB outcomes. We aimed to analyze the trends of TB in Bahir Dar, Northwest Ethiopia, over 5 years from 2015 to 2019. Methods: An institution-based, retrospective cross-sectional study was conducted in Bahir Dar, the capital city of the Amhara Region in Ethiopia. Five-year data and records of individual TB cases were reviewed from all public and private health-care facilities and health bureaus in Bahir Dar. Using a standard checklist adapted from the World Health Organization, data were abstracted relevant to sociodemographic characteristics of the patients, year and type of TB infection, and HIV status. SPSS version 20 software was used for data analysis. Results: Data of 4275 patients with TB were identified, of which 929 (21.7%) were smear-positive pulmonary TB, 1195 (28%) were smear-negative pulmonary TB, and 2151 (50.3%) were extrapulmonary TB patients. TB was more prevalent in the age group 15-34 years (51.2%), and females (55.5%). In the years from 2015 to 2019, the prevalence of all forms of TB was 922 (21.6%), 812 (19.0%), 843 (19.7%), 876 (20.5%), and 822 (19.2%), respectively, demonstrating a decreasing trend though inconsistent. The variables sex (adjusted odds ratio [AOR]: 1.734, 95% confidence interval [CI] [1.390-2.187]), HIV co-infection (AOR: 1.875, 95% CI [1.553-2.265]), and age <15 years (AOR: 1.372, 95% CI [1.121-1.680]) showed a significant association with TB infection. Conclusions: The prevalence of TB in Bahir Dar, Northwest Ethiopia, demonstrated a decreasing trend over the years from 2015 to 2019 but with inconsistencies. HIV co-infection significantly increased the risk of developing TB, and productive age groups and females were at the greater prevalence of TB, highlighting the importance of strengthening sustainable TB care and prevention interventions toward these groups of people.


Assuntos
Coinfecção , Tuberculose , Adolescente , Adulto , Coinfecção/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Estudos Retrospectivos , Tuberculose/epidemiologia , Adulto Jovem
14.
PLoS One ; 16(12): e0260722, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932602

RESUMO

INTRODUCTION: The Geshiyaro project aims to break transmission of soil-transmitted helminths and schistosomiasis in the Wolaita Zone of Ethiopia through a combination of two interventions: behavior change communication (BCC) for increased water, sanitation and hygiene (WaSH) infrastructure use alongside preventive chemotherapy (PC) using albendazole (ALB) and praziquantel (PZQ), targeted to reach 90% treatment coverage. Coverage evaluation surveys (CES) were conducted post-treatment, and the resultant survey coverage was compared to reported administrative coverage. This provided a secondary confirmation of the Geshiyaro project coverages, and is used to monitor the success of each Mass Drug Administration (MDA) round. METHODS: A community-based cross-sectional study was conducted in 13 woredas (districts) of the Wolaita Zone. All eligible individuals from the selected households were invited for an interview. The study design, sample size, analysis and report writing were conducted according to the World Health Organization (WHO) CES guidelines for PC. RESULTS: The study interviewed a total of 3,568 households and 18,875 individuals across 13 woredas in the Wolaita Zone. Overall, the survey coverage across all studied woredas was 81.5% (95% CI; 80.9-82.0%) for both ALB and PZQ. Reported administrative coverage across all studied woredas was higher than survey coverage, 92.7% and 91.2% for ALB and PZQ, respectively. A significant portion of individuals (17.6%) were not offered PC. The predominant reason for not achieving the target coverage of 90% was beneficiary absenteeism during MDA (6.6% ALB, 6.8% PZQ), followed by drug distributors failing to reach all households (4.7% ALB, 4.8% PZQ), and beneficiaries not informed of the program (1.3% ALB, 1.7% PZQ). CONCLUSION: Programmatic actions will need to be taken during the next MDA campaign to achieve the targeted Geshiyaro project coverage threshold across data collection and program engagement. Adequate training and supervision on recording and reporting administrative coverage should be provided, alongside improved social mobilization of treated communities to increase participation, and strengthened institutional partnerships and communication.


Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Quimioprevenção/métodos , Helmintíase/prevenção & controle , Praziquantel/administração & dosagem , Esquistossomose/prevenção & controle , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Estudos Transversais , Etiópia/epidemiologia , Características da Família , Feminino , Helmintíase/epidemiologia , Helmintíase/parasitologia , Helmintíase/transmissão , Humanos , Higiene/educação , Lactente , Masculino , Administração Massiva de Medicamentos/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Saneamento/métodos , Esquistossomose/epidemiologia , Esquistossomose/parasitologia , Esquistossomose/transmissão , Solo/parasitologia , Inquéritos e Questionários
15.
PLoS One ; 16(12): e0261581, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932611

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. METHODS: An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. RESULTS: A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2-56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. CONCLUSION: Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Sexo Seguro/psicologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Terapia Antirretroviral de Alta Atividade , Comportamento Contraceptivo/estatística & dados numéricos , Aconselhamento/organização & administração , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Hospitais Gerais , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Sexo Seguro/estatística & dados numéricos , Parceiros Sexuais/psicologia , Inquéritos e Questionários
16.
Malar J ; 20(1): 483, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34952581

RESUMO

BACKGROUND: Ethiopia is one of the few countries in Africa where Plasmodium vivax commonly co-exists with Plasmodium falciparum, and which accounts for ~ 40% of the total number of malaria infections in the country. Regardless of the growing evidence over many decades of decreasing sensitivity of this parasite to different anti-malarial drugs, there has been no comprehensive attempt made to systematically review and meta-analyse the efficacy of different anti-malarial drugs against P. vivax in the country. However, outlining the efficacy of available anti-malarial drugs against this parasite is essential to guide recommendations for the optimal therapeutic strategy to use in clinical practice. The aim of this study was to synthesize evidence on the efficacy of anti-malarial drugs against clinical P. vivax malaria in Ethiopia. METHODS: All potentially relevant, peer-reviewed articles accessible in PubMed, Scopus, Web of Science, and Clinical Trial.gov electronic databases were retrieved using a search strategy combining keywords and related database-specific subject terms. Randomized controlled trials (RCTs) and non-randomized trials aiming to investigate the efficacy of anti-malarial drugs against P. vivax were included in the review. Data were analysed using Review Manager Software. Cochrane Q (χ2) and the I2 tests were used to assess heterogeneity. The funnel plot and Egger's test were used to examine risk of publication bias. RESULTS: Out of 1294 identified citations, 14 articles that presented data on 29 treatment options were included in the analysis. These studies enrolled 2144 clinical vivax malaria patients. The pooled estimate of in vivo efficacy of anti-malarial drugs against vivax malaria in Ethiopia was 97.91% (95% CI: 97.29-98.52%), with significant heterogeneity (I2 = 86%, p < 0.0001) and publication bias (Egger's test = -12.86, p < 0.001). Different anti-malarial drugs showed varied efficacies against vivax malaria. The duration of follow-up significantly affected the calculated efficacy of any given anti-malarial drug, with longer duration of the follow-up (42 days) associated with significantly lower efficacy than efficacy reported on day 28. Also, pooled PCR-corrected efficacy and efficacy estimated from altitudinally lower transmission settings were significantly higher than PCR-uncorrected efficacy that estimated for moderate transmission settings, respectively. CONCLUSION: The overall efficacy of anti-malarial drugs evaluated for the treatment of vivax malaria in Ethiopia was generally high, although there was wide-ranging degree of efficacy, which was affected by the treatment options, duration of follow-up, transmission intensity, and the confirmation procedures for recurrent parasitaemia. Regardless of evidence of sporadic efficacy reduction reported in the country, chloroquine (CQ), the first-line regimen in Ethiopia, remained highly efficacious, supporting its continuous utilization for confirmed P. vivax mono-infections. The addition of primaquine (PQ) to CQ is recommended, as this is the only approved way to provide radical cure, and thus ensure sustained efficacy and longer protection against P. vivax. Continuous surveillance of the efficacy of anti-malarial drugs and clinical trials to allow robust conclusions remains necessary to proactively act against possible emergence and spread of drug-resistant P. vivax in Ethiopia.


Assuntos
Antimaláricos/uso terapêutico , Malária Vivax/prevenção & controle , Plasmodium vivax/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Etiópia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
17.
J Ethnobiol Ethnomed ; 17(1): 71, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34952609

RESUMO

BACKGROUND: Medicinal plants have been used for ages in Ethiopia. Some 887 plant species have been documented to heal human and livestock health problems. Documenting the traditional use of medicinal plants is a vital step in obtaining information on bioactive chemicals, preserving indigenous knowledge and ultimately interesting, medicinal plant species. We conducted this study with the aim of documenting the ethnobotanical knowledge associated with medicinal plant use in Adwa District, Northern Ethiopia. METHODS: The study was conducted from September 2018 to December 2019. A total of 393 informants (242 males and 151 females) were selected. Data were collected using semi-structured interviews, guided walks and group discussions. We calculated informant consensus factors (ICF) and fidelity level (FL) and performed ranking and paired comparisons. Data were analysed using descriptive statistics, including independent sample t test and ANOVA. RESULTS: Overall, we documented 127 medicinal plants belonging to 105 genera, under 54 families to be used by local people to address 43 human and 15 livestock ailments. Families Fabaceae and Solanaceae were the most important ones with 11 (8.66%) species each. Herbs were the dominant growth form (55 species), followed by shrubs (39). The most frequently used plant parts were leaves (24.27%) followed by roots (14%). The most important preparation method was crushing and pounding (42.7%) followed by fumigation (smoke and vapour) (23, 11.1%). The common route of administration was via skin application (67 or 32%) followed by oral (63, 27%). ICF showed that tonsillitis had the higher value (0.95). Cucumis ficifolius A. Rich. was the most preferred medicinal plant (36) treating abdominal pain, followed by Kalanchoe quartiniana A. Rich. for blackleg (34). CONCLUSIONS: Adwa District is relatively rich in medicinal plant diversity and traditional knowledge on use, preparation and application of the medicinal flora. However, agricultural expansion (51%), overgrazing (43%) and drought (37%) were mentioned most when informants were asked about the threats to medicinal plants in Adwa District. Hence, on-site and off-site medicinal plant conservation would help protect medicinal plants in the district.


Assuntos
Plantas Medicinais , Etiópia , Etnobotânica , Humanos , Medicina Tradicional Africana , Fitoterapia
18.
PLoS One ; 16(12): e0261065, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928975

RESUMO

BACKGROUND: Curtailing physical contact between individuals reduces transmission and spread of the disease. Social distancing is an accepted and effective strategy to delay the disease spread and reduce the magnitude of outbreaks of pandemic COVID-19. However, no study quantified social distancing practice and associated factors in the current study area. Therefore, the study aimed to assess social distancing practice and associated factors in response to COVID-19 pandemic in West Guji Zone, Southern Ethiopia, 2020. METHODS AND MATERIALS: A Community based cross-sectional study design was conducted among randomly selected 410 household members of Bule Hora Town, West Guji Zone. Data were collected by pre-tested interviewer administered structured questionnaire adapted from previous peer reviewed articles. The data were coded and entered in to Epi data version 3.5 and analyzed by SPSS version 23. The bivariate and multivariate logistic regressions analysis was done to identify factors associated with social distancing practice. Adjusted odds ratio with 95% confidence interval and p value <0.05 were used to declare statistical significance. RESULT: Out of 447 planned samples, 410 participants were successfully interviewed and included into final analysis; making the response rate of 91.7%. The median (±IQR) age of study participants was 28(±9) years. In this study, 38.3% [95% CI: 33.5%, 43.1%)] of the study participants have good social distancing practices for the prevention of COVID-19. Age group 26-30 years [AOR = 2.56(95% CI: 1.18-5.54)] and 31-35 years [AOR = 3.57(95%CI: 1.56-8.18)], employed [AOR = 6.10(95%CI: 3.46-10.74)],poor knowledge [AOR = 0.59 (95% CI:0.36-0.95)], negative attitude [AOR = 0.55 (95% CI:0.31-0.95)] and low perceived susceptibility [AOR = 0.33(95%CI: 0.20-0.54)] were significantly associated with good social distancing practice. CONCLUSION: Social distancing practice is relatively poor in the study area. The knowledge and attitude level of participants were identified to be the major factors for the observed poor social distancing practice. Sustained efforts to improve awareness and attitudes towards COVID-19 prevention might improve adherence to social distancing practices.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Distanciamento Físico , Adulto , COVID-19/psicologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Fatores de Risco , Autoeficácia , Fatores Socioeconômicos , Adulto Jovem
19.
J Environ Public Health ; 2021: 6158769, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956372

RESUMO

Background: Foodborne diseases remain a major public health problem globally, but the problem is severe in developing countries like Ethiopia. The objective of this study was to assess food safety practices and associated factors among food handlers of Fiche town. Methods: A cross-sectional study was conducted among 422 food handlers working in food and drink establishments. The data were collected using a structured questionnaire and observational checklist. Data were entered and coded into SPSS for analysis. Multivariable logistic regression was used to identify the predictor variables associated with the practice of food handlers (p < 0.05). Result: 61.6% of food handlers knew the potential risk of contaminating food with dirty hands, and 70% washed hands with soap before working with food. 52.8% of food handlers covered the hair with restraints. 66.8% of food handlers used outer garments, and the majority of food handlers (71.1%) had a trimmed fingernail. Two hundred thirteen (50.5%) of food handlers had good food handling practices. Medical checkup (AOR = 3.16; 95% CI 1.89, 5.26), sanitary inspection (AOR = 1.76; 95% CI 1.16, 2.69), knowledge (AOR = 2.31; 95% CI 1.53, 3.48), service year (AOR = 3.11; 95% CI 1.53, 6.31), and educational status (AOR = 3.42, 95% CI 1.29, 9.04) were found to be significantly associated with food handling practices. Conclusion: The food handlers should take various training concerning food hygiene and safety to enhance their knowledge and practice. Regular sanitary inspection of food and drink establishments is recommended.


Assuntos
Inocuidade dos Alimentos , Doenças Transmitidas por Alimentos , Estudos Transversais , Etiópia , Manipulação de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos
20.
BMC Public Health ; 21(1): 2297, 2021 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922501

RESUMO

BACKGROUND: COVID-19 has been swiftly spreading throughout the world ever since it emerged in Wuhan, China, in late December 2019. Case detection and contact identification remain the key surveillance objectives for effective containment of the pandemic. This study was aimed at assessing performance of surveillance in early containment of COVID 19 in Western Oromia, Ethiopia. METHODS: A cross-sectional study was conducted from August 1 to September 30, 2020, in the 7 kebeles of Nekemte and 2 kebeles of Shambu Town. Residents who lived there for at least the past six months were considered eligible for this study. Data were collected from community and health system at different levels using semi structured questionnaire and checklist, respectively. Participants' health facility usage (dependent variable) and perceived risk, awareness, Socioeconomic Status, and practices (independent variable) were assessed. Bivariable analysis was computed to test the presence of an association between dependent and independent variables. Independent predictors were identified on multivariable logistic regression using a p-value of (<0.05) significance level. We have checked the model goodness of fit test by Hosmer-lemeshow test. RESULTS: One hundred seventy-nine (41%) of the participants believe that they have a high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they were not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. Three (33%) of the assessed health posts didn't have community volunteers. On multivariable logistic regression analysis, the source of income AOR=0.30, 95% CI (0.11, 0.86), perceived level of risk AOR=3.42, 95% CI (2.04, 5.7) and not visited by health extension workers AOR=0.46, 95% CI (0.29, 0.74) were found to be independent predictors of not using health facilities during this pandemic. CONCLUSION: Event based surveillance, both at community and health facility level, was not performing optimally in identifying potential suspects. Therefore, for effective early containment of epidemic, it is critical to strengthen event based surveillance and make use of surveillance data for tailored intervention in settings where mass testing is not feasible.


Assuntos
COVID-19 , Estudos Transversais , Etiópia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , SARS-CoV-2
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