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BACKGROUND: The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID-19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider. METHODS: This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out. MAIN TEXT: The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure. CONCLUSIONS: To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems.
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COVID-19 , Saúde Global , Pandemias , Humanos , África/epidemiologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Financiamento da Assistência à Saúde , Pandemias/prevenção & controleRESUMO
There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR = 60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.
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Neoplasias do Colo do Útero/patologia , Listas de Espera/mortalidade , Progressão da Doença , Etiópia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Fatores de Tempo , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapiaRESUMO
PURPOSE: Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia. METHODS: Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis. RESULTS: The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors' grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31; p = 0.001), had patient delay of > 3 months (aPR = 1.16; p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24; p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77; p = 0.021). CONCLUSIONS: Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.
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Neoplasias da Mama , Diagnóstico Tardio , Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , PrognósticoRESUMO
PURPOSE: Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia. METHODS: A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017-2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC > 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC > 90 days was associated with sociodemographic or clinical factors. RESULTS: The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4-36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ < 61) was 3.98 (95% CI 1.67-9.46) higher than in those women with highest quartile family income group (US$ > 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients. CONCLUSIONS: A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.
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Neoplasias da Mama , Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Quimioterapia Adjuvante , Etiópia/epidemiologia , Feminino , HumanosRESUMO
BACKGROUND: End-Stage Kidney Disease, the most severe form of chronic kidney disease, is fatal if not treated by renal replacement therapy. Thus, patients with End-Stage Kidney Disease depend on hemodialysis as a lifesaving treatment for the remainder of their lives. However, the health-related quality of life (HRQOL) of patients on hemodialysis is much more underappreciated in resource limited countries. METHODS: A hospital based cross-sectional study was conducted in Addis Ababa, Ethiopia, from August 01 to October 31, 2019. All patients who were on hemodialysis in five randomly selected public and private hospitals (n = 125) were included in the study. Data were administered by trained nurses by using a standardized Kidney Disease Quality of Life questionnaire. Clinical data were extracted from the patients' medical charts. HRQOL was categorized as low, if the overall mean score was ≤ 50, or as high, if the overall mean score was > 50. Factors associated with lower HRQOL were identified by multi-variable binary logistic regression analysis and expressed by adjusted odds ratio (aOR) and its respective 95 % confidence interval. RESULTS: The mean age of the study participants (n = 125) was 50.33 years (± 15.07) and more than two-thirds (68.8 %) of the participants were males. The mean score of HRQOL was 49.08 ± 11.09, with 48.0 % (95 % CI: 42.2 - 54.5 %) of them had lower HRQOL. Unemployed patients (aOR = 2.40, 95 % CI: 1.10-5.90) and patients who had hemodialysis 2 times per week (aOR = 1.71, 95 % CI: 1.07-3.83) had lower HRQOL. Elderly patients had higher odds of having lower mean score on the burden of kidney disease (aOR = 2.07; 95 % CI 1.18-4.13) as compared to the younger patients. CONCLUSIONS: Nearly half of the patients with ESKD on hemodialysis had lower overall HRQOL which is associated with their unemployment status and frequency of hemodialysis per week. Elderly patients had lower mean score of burden of kidney disease. Therefore, quality of life of patients with chronic dialysis should be given special attention during the patients' care. Measures should be taken by the government to ensure accessibility and affordability of the hemodialysis services in the country.
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Falência Renal Crônica , Qualidade de Vida , Diálise Renal , Fatores Etários , Efeitos Psicossociais da Doença , Estudos Transversais , Etiópia/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Diálise Renal/psicologia , Inquéritos e Questionários , Desemprego/estatística & dados numéricosRESUMO
BACKGROUND: Data on COVID-19 vaccine effectiveness to support regional vaccine policy and practice are limited in Africa. Thus, this review aimed to evaluate the efficacy and effectiveness of COVID-19 vaccines administered in Africa. METHODS: We systematically searched peer-reviewed randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies that reported on VE in Africa. We carried out a risk of bias assessment, and the findings of this review were synthesized and presented in a narrative form, including tables and figures. The synthesis was focused on COVID-19 VE against various levels of the disease condition and outcomes (infection, hospitalization or critical, and death), time points, and variants of concern. RESULTS: A total of 13 studies, with a total sample size of 913,285 participants, were included in this review. The majority (8/13) of studies were from South Africa and 38.5% (5/13) were randomized clinical trials. The studies reported that a full dose of Pfizer-BioNTech vaccine had a VE of 100% against COVID-19 infection by Beta (B.1.351) and Delta variants and 96.7% against hospitalization by Delta variant. The Johnson and Johnson vaccine had VE ranging from 38.1%-62.0% against hospitalization and 51.9%- 86% against critical disease by Beta (B 1.351) variant. The Oxford-AstraZeneca vaccine had a VE of 89.4% against hospitalization by the Omicron variant but was not effective against the B.1.351 variant (10.4%). The Sinopharm vaccine had a VE of 67% against infection and 46% against hospitalization by Delta variant. CONCLUSIONS: COVID-19 vaccines administered in Africa were effective in preventing infections, hospitalization, and death. These review findings underscore the need for concerted efforts of all stakeholders to enhance the access and availability of COVID-19 vaccines and reinforce public awareness to reach the high-risk, unvaccinated group of the African population.
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Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Humanos , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , COVID-19/epidemiologia , SARS-CoV-2/imunologia , África/epidemiologia , Eficácia de Vacinas , Hospitalização/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Delivering COVID-19 vaccines with 4-6 weeks shelf life remains one of Africa's most pressing challenges. The Africa Centres for Disease Control and Prevention (Africa CDC) leadership recognised that COVID-19 vaccines donated to many African countries were at risk of expiry considering the short shelf life on delivery in the Member States and slow vaccine uptake rates. Thus, a streamlined rapid response system, the urgent support mechanism, was developed to assist countries accelerate COVID-19 vaccine uptake. We describe the achievements and lessons learnt during implementation of the urgent support mechanism in eight African countries. An Africa CDC team was rapidly deployed to meet with the Ministry of Health of each country alerted for COVID-19 vaccine expiry and identified national implementing partners to quickly develop operational work plans and strategies to scale up the urgent use of the vaccines. The time between the initiation of alerts to the start of the implementation was typically within 2 weeks. A total of approximately 2.5 million doses of vaccines, costing $900 000, were prevented from expiration. The urgent support has also contributed to the increased COVID-19 vaccination coverage in the Member States from 16.1% at the initiation to 25.3% at the end of the urgent support. Some of the effective strategies used by the urgent support mechanism included coordination between Africa CDC and country vaccine task forces, establishment of vaccination centres, building the capacity of routine and surge health workforce, procurement and distribution of vaccine ancillaries, staff training, advocacy and sensitisation events, and use of trusted religious scriptures and community influencers to support public health messages. The urgent support mechanism demonstrated a highly optimised process and serves as a successful example for acceleration and integration of vaccination into different healthcare delivery points.
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Vacinas contra COVID-19 , COVID-19 , Humanos , África , COVID-19/prevenção & controle , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/provisão & distribuição , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Participação da Comunidade , Vacinação/economia , Vacinação/métodosRESUMO
SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients' data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1-35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4-10.0) patients, and 64 (1.3%, 95% CI: 1.0-1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15-3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07-0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI.
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BACKGROUND: The COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia. METHODS: COVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data were captured by standardized tools and formats. Analysis of COVID-19 testing performed, cases detected, and deaths registered by region and time was carried out. RESULTS: We analyzed 215,024 individuals' data that were captured through COVID-19 surveillance in Ethiopia. Of the 215,024 total tests, 18,964 COVID-19 cases (8.8%, 95% CI: 8.7%- 9.0%) were identified and 534 (2.8%, 95% CI: 2.6%- 3.1%) were deceased. The positivity rate ranged from 1% in the Afar region to 15% in the Sidama region. Eight (1.2%, 95% CI: 0.4%- 2.0%) HCWs died out of 664 infected HCWs, of which 81.5% were from Addis Ababa. Three waves of outbreaks were detected during the analysis period, with the highest positivity rate of 35% during the Omicron period and the highest rate of ICU beds and mechanical ventilators (38%) occupied by COVID-19 patients during the Delta period. CONCLUSIONS: The temporal and regional variations in COVID-19 cases and deaths in Ethiopia underscore the need for concerted efforts to address the disparities in the COVID-19 surveillance and response system. These lessons should be critically considered during the integration of the COVID-19 surveillance system into the routine surveillance system.
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PURPOSE: There are limited data on the association between delay in breast cancer diagnosis after breast symptom recognition and survival, particularly in sub-Saharan Africa. The recently launched Global Breast Cancer Initiative by WHO includes measuring delay as the core indicator for quality of breast cancer care. Herein, we examined the association between delay in breast cancer diagnosis with overall survival among women in Addis Ababa, Ethiopia. MATERIALS AND METHODS: A total of 439 women diagnosed with breast cancer from January 1, 2017, to June 30, 2018, in Addis Ababa were followed for survival to the end of 2019. Survival rates were estimated using the Kaplan-Meier method. The association between delay in diagnosis (>3 months after symptom recognition) and overall survival was computed using the multivariable Cox regression model after adjusting for demographic and clinical factors. RESULTS: Nearly 70% (303/439) of women with breast cancer were delayed in diagnosis of their cancer. During a median follow-up period of 25.1 months, 2-year overall survival rate was 73.5% (95% CI, 68.0 to 78.2) in women with diagnosis delay compared with 79.1% (95% CI, 71.2 to 85.1) in those women without diagnosis delay. In the multivariable Cox regression model, the risk of death was 73% higher (hazard ratio, 1.73; 95% CI, 1.09 to 2.74) in women with diagnosis delay compared with those without diagnosis delay. CONCLUSION: Delay in diagnostic confirmation of breast cancer after recognition of breast symptoms was negatively associated with overall survival in Addis Ababa, Ethiopia, underscoring the need to increase awareness about the importance of prompt presentation for clinical evaluation and referral for diagnostic confirmation to mitigate the undue high burden of the disease.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Estudos Prospectivos , Etiópia/epidemiologia , MamaRESUMO
OBJECTIVE: Data on COVID-19 vaccine hesitancy is limited in Ethiopia and other parts of Africa. Therefore, the aim of this study was to determine the level of COVID-19 vaccine hesitancy and its associated factors in Addis Ababa, Ethiopia. DESIGN: A community-based concurrent mixed-method study. SETTING: In a community setting. PARTICIPANTS: Adult residents (n=422) of Akaki Kality subcity who were recruited by a two stage sampling technique and 24 adults who were selected purposively were included for the quantitative and qualitative part of the study respectively. OUTCOME MEASURES: Data were collected by face-to-face interview using a semistructured questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified by multivariable binary logistic regression model. RESULTS: One out five (19.1%, 95% CI 15.3% to 24.6%) participants were not willing to get vaccinated. In the multivariable analysis, vaccine hesitancy was significantly associated with being female (aOR=1.97; 95% CI 1.10 to 3.89), having negative attitude towards COVID-19 and its preventive measures (aOR=1.75; 95% CI 1.08 to 3.02), and primary information source being social media (internet) (aOR=3.59; 95% CI 1.75 to 7.37). Study participants have predominantly stated that they did not have enough information about the vaccine, feared it would not be effective or have too many side effects, and reflected their uncertainty towards the quality of the vaccine. CONCLUSIONS: A considerable proportion of the people in Addis Ababa have concerns on COVID-19 vaccines and unwilling to accept them. This was due to the misconceptions, negative attitudes and use of social media as their primary source of information. Providing the community with health education and consistent efforts to enhance the prevention measures are important, particularly using different medias including social media.
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COVID-19 , Vacinas , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Hesitação VacinalRESUMO
INTRODUCTION: Diabetes is a global public health threat with a considerably high burden in low- and middle-income countries. The application of self-care practice by people living with diabetes helps to manage diabetes and its complications, and to lengthen their life. However, the level of diabetes self-care practice in Ethiopia is very low. METHODS: A cross-sectional study was conducted among people living with type 2 diabetes who were on follow-up from January 01 to 31, 2019 at Yekatit 12 Hospital. A systematic sampling technique was employed to recruit 354 study participants. A face-to-face interview was administered by trained data collectors using a structured questionnaire. Diabetes self-care practice was assessed by using Summary of Diabetes Self-Care Activities (SDSCA) scale. Multi-variable binary logistic regression analysis was carried out to identify factors associated with diabetes self-care practice. RESULTS: More than half (52.0%, 95% CI: 49.9% - 57.1%) of the people living with diabetes had poor diabetes self-care practice. Poor self-care practice was associated with being unemployed and retired (AOR= 3.57, 95% CI 1.65-7.72), having diabetes for ≥10 years (AOR= 1.78, 95% CI 1.07-2.95), having comorbidity (AOR= 2.15, 95% CI 1.35-3.43), not owning glucometer (AOR= 1.81, 95% CI 1.16-2.83), not receiving diabetes education (AOR= 1.95, 95% CI 1.20-3.18) and dissatisfaction with social support (AOR= 4.24, 95% CI 1.25-14.40). CONCLUSION: Poor self-care practice was found to be substantial among people living with diabetes in Addis Ababa, with self-monitoring of blood glucose and regular exercise being the least performed. It is beneficial to focus more on lifestyle modifications and educating about the severity of the disease for better management of blood sugar levels and hindrance of complications.
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BACKGROUND: Childhood undernutrition is a global problem contributing to more than a third of under-five mortality. Orphans and vulnerable children (OVC) fare worse than children living with their parents. However, the nutritional and healthcare needs of OVC are under-recognized in Ethiopia. METHODS: A community-based cross-sectional study was conducted among OVC aged 6 to 59 months. Multi-stage sampling technique was applied to select the households and eligible children included in the study (n = 584). An interviewer-administered questionnaire and anthropometric measurements were carried out. The proportions of stunting, wasting and underweight were determined based on the WHO Z-score cut-off. Factors associated with stunting were identified by Multivariable binary logistic regression analysis. RESULTS: The prevalence of stunting, wasting and underweight were 35.1% (95% CI; 31.3-39.1%), 4.7% (95% CI; 3.2-6.7%) and 12.0% (95% CI; 9.6-14.9%), respectively. Stunting was significantly associated with initiation of complementary feeding after 12 months of age (AOR = 3.61; 95% CI 1.16-14.11), household food insecurity (AOR = 1.90; 95% CI 1.10-3.17), unplanned pregnancy (AOR = 1.90; 95% CI 1.03-3.42), age ≥ 2 years (AOR = 1.80; 95% CI 1.25-2.67), caretaker's age ≤ 25 years (AOR = 1.50; 95% CI 1.03-2.16) and employment of the caretaker (AOR = 1.50; 95% CI 1.03-2.26). CONCLUSION: The prevalence of all forms of undernutrition among OVC was significantly higher than the national estimate that has been reported by consecutive Ethiopian Demographic and Health Surveys (EDHS). Policy makers and programmers working on nutritional interventions should give due emphasis to address the unmet need of OVC and focus on interventions which enhance household food security and caretaker's awareness on child feeding and pregnancy planning.
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BACKGROUND: Cervical cancer is one of the most diagnosed and deadly cancers in women globally. Though vaccination is an effective way to reduce cervical cancer, people's knowledge and acceptance of the vaccination remains a challenge in low and middle-income countries. Therefore, the aim of this study was to assess the level of knowledge and acceptance of Human Papilloma Virus (HPV) vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia. METHODS: A community-based cross-sectional study was conducted among parents or guardians whose daughters are in the age group of 9-17 years and residing in Akaki-Kalty sub-city in Addis Ababa. A multistage sampling technique was used to select the study participants (n = 430). Face-to-face interview was conducted by using a structured questionnaire. Factors associated with the acceptance of HPV vaccination was identified by multivariable binary logistic regression and expressed by adjusted odds ratio (aOR), and respective 95% confidence interval. RESULTS: Complete response was obtained from 422 (98.1%) of the participants and their mean age was 39.0 years (SD ± 9.9). Out of the study participants, 41.7% and 72.0% had poor knowledge on cervical cancer and HPV, respectively. More than a quarter (27.0%) of the participants has never heard about HPV vaccine. One-third (36.5%) of the participants had negative attitude towards the HPV vaccine. Overall, 94.3% of the study participants were willing to vaccinate their daughters for HPV. Vaccine acceptability was associated with higher monthly income (aOR = 2.48, 95% CI 1.08-6.34), good knowledge on HPV (aOR = 2.32, 95% CI 1.56-4.87) and the vaccine (aOR = 2.24, 95% CI 1.12-8.60), and positive attitude towards the vaccine (aOR = 5.03, 95% CI 1.63-9.56). CONCLUSIONS: The overall HPV vaccine acceptance was high. However, two out of five and one-thirds of the parents had poor knowledge on cervical cancer and negative attitude towards the HPV vaccine, respectively. Higher monthly income, good knowledge on HPV and the vaccine, and positive attitude towards the vaccine were associated with acceptance of HPV vaccination. To ensure sustainable acceptance of HPV vaccination, it is crucial to increase the community awareness in a sustainable manner.
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OBJECTIVE: Hypertension is a global public health problem, with its burden increasing particularly in developing countries. However, it has not yet received due attention in Ethiopia. The aim of this study was to determine the prevalence and associated factors of hypertension among adult population in Hosanna town, southern Ethiopia. DESIGN: Community-based cross-sectional study. SETTING: Hosanna town, southern Ethiopia. PARTICIPANTS: Adult population aged ≥18 years (n=634) were recruited by a multistage stratified sampling technique. OUTCOME MEASURES: A face-to-face interview using structured questionnaire was carried out by trained nurses. Anthropometry and blood pressure were measured following standard procedures. Hypertension status was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg in two separate measurements or reported use of prescribed antihypertensive drugs for raised blood pressure. Factors associated with hypertension were identified by multivariable binary logistic regression analysis. RESULTS: The overall prevalence of hypertension was found to be 17.2% (19.3% and 14.2% among men and women, respectively). About 40% were unaware that they were hypertensive prior to the study. Older age ≥35 years (adjusted OR=3.9, 95% CI: 1.4 to 10.8), alcohol use (adjusted OR=3.4, 95% CI: 1.4 to 8.3), consumption of saturated oil (adjusted OR=6.5, 95% CI: 1.5 to 17.5) and unspecified different types of oil (adjusted OR=8.2, 95% CI: 1.9 to 25.1) and overweight/obesity (adjusted OR=2.9, 95% CI: 1.9 to 4.6) were found to be independently associated with hypertension. CONCLUSIONS: The prevalence of both diagnosed and undiagnosed hypertension is alarmingly high in the town. These findings underscore the need to design health information provision systems on the risk factors of hypertension and promote good health practices. Blood pressure screening programmes at community levels to identify and treat undiagnosed hypertension should be considered.
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Hipertensão , Adolescente , Adulto , Idoso , Anti-Hipertensivos , Pressão Sanguínea , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Prevalência , Fatores de RiscoRESUMO
Background/Objectives: Diabetes is a global public health problem, and its burden is rising, particularly in developing countries. However, limited data is available from sub-Sahara African communities to assess and monitor the disease burden. The study aimed to determine the prevalence and associated factors of diabetes in Hosanna, Ethiopia. Methods: A community-based cross-sectional study was conducted among 634 randomly selected adults in Hosanna. The study participants were recruited by multi-stage stratified sampling. A face-to-face interview using a structured questionnaire was administered by trained nurses. Anthropometry, blood pressure and fasting blood glucose levels were measured. Diabetes mellitus was considered when the fasting blood glucose level was ≥126 mg/dl on two separate measurements or when the participant self-reported a previous diagnosis of diabetes by healthcare providers or when the participant was currently receiving treatment for diabetes. Multi-variable binary logistic regression was used to identify factors associated with diabetes mellitus. Findings: The overall prevalence of diabetes was found to be 5.7% (95% CI; 4.0-7.7), out of which more than one third (36%) were not aware of it prior to the survey. Nearly two thirds (61.1%) of the diabetic participants were also found to be hypertensive. In the multi-variable analysis, diabetes was associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive. Conclusion: The prevalence of diabetes among the adult population in the town is alarming. If appropriate measures to address the burden are not emplaced, it might result in serious complications to the patients and unnecessarily high costs to the health system of the country. Active screening for raised blood glucose level should be given due consideration, particularly in the community setting. Designing health education programs on the importance of physical activity and the risks of alcohol use should also be considered.
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Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Comportamento Sedentário , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Diabetes Mellitus/terapia , Dietoterapia , Etiópia/epidemiologia , Exercício Físico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Modelos Logísticos , Masculino , Medicinas Tradicionais Africanas , Sobrepeso/epidemiologia , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Intrauterine Contraceptive Device (IUCD) is a highly effective and reversible modern contraceptive, which is still significantly underutilized in Ethiopia. The aim of this study was to identify factors affecting the use of IUCDs among women of reproductive age group in Addis Ababa. METHODS: Facility-based, unmatched case-control study was employed among randomly selected cases and controls in selected health centers in Addis Ababa from August to October 2017. The cases (n = 128) were women of reproductive age group who were IUCD users and controls (n = 256) were women of reproductive age group who were users of oral or injectable contraceptives during the study period. After randomly selecting two health center from each sub-city the number of cases and controls were equally allocated to each of the selected health centers. In each selected health center, all eligible cases were enrolled consecutively until the sample size was achieved. Two consecutive controls were selected for each case. Data was collected face-to-face by trained nurses by using structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward conditional stepwise method. RESULTS: In the multi-variable analysis, IUCD use was strongly associated with husbands/partners being supportive of IUCD use (Adjusted OR = 13.24, 95% CI; 5.30-33.02), being literate women (Adjusted OR = 5.31, 95% CI; 1.05-26.93), women having a perception of IUCD does not cause infection (Adjusted OR = 4.38, 95% CI; 1.45-13.26) and the source of information about IUCD being mass-media (Adjusted OR = 3.81, 95% CI; 1.49-9.74). CONCLUSIONS: The findings of the study reinforce the need of husbands/partners involvement in the interventions to enhance utilization of IUCD. Moreover, due attention should also be provided for delivering IUCD-related messages in the public mass-media.
Assuntos
Dispositivos Intrauterinos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Razão de Chances , Cooperação e Adesão ao Tratamento/psicologia , Adulto JovemRESUMO
OBJECTIVE: To describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia. DESIGN: A population-based cross-sectional study. SETTING: Seven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia. PARTICIPANTS: All histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents. OUTCOME MEASURES: The proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model. RESULTS: The mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51). CONCLUSIONS: Our findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.
Assuntos
Neoplasias do Colo do Útero , Adulto , Idoso , Estudos Transversais , Detecção Precoce de Câncer , Etiópia/epidemiologia , Feminino , Instalações de Saúde , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologiaRESUMO
PURPOSE: A substantial proportion of cervical cancers are diagnosed at advanced stage in Ethiopia. Therefore, the aim of this study was to determine the extent and predictors of delays in cervical cancer diagnosis in Addis Ababa. PATIENTS AND METHODS: We prospectively recruited 231 patients with cervical cancer diagnosed from January 1, 2017, to June 30, 2018, in 7 health facilities in Addis Ababa, representing 99% of all cervical cancers recorded in the Addis Ababa population-based cancer registry. A structured questionnaire on patients' experience was administered face to face by trained interviewers. Health-seeking intervals > 90 days (date from recognition of symptoms to medical consultation) and diagnostic intervals > 30 days (dates from medical consultation to diagnostic confirmation) were categorized as delayed. Factors associated with these delays were assessed using multivariable binary logistic regression models. RESULTS: The median health-seeking and diagnostic intervals for patients with cervical cancer in Addis Ababa were 10 and 97 days, respectively. Approximately one quarter of the patients were delayed in seeking medical consultation, and three fourths of the patients had delayed diagnostic confirmation. Factors associated with health-seeking delays included poor cervical cancer awareness, practicing of religious rituals, and waiting for additional symptoms before visiting a health facility. Factors associated with diagnostic delays included first contact with primary health care units and visits to ≥ 4 different health facilities before diagnosis. CONCLUSION: A considerable proportion of patients with cervical cancer in Addis Ababa have delays in seeking medical care and diagnostic conformation. These findings reinforce the need for programs to enhance awareness about cervical cancer signs and symptoms and the importance of early diagnosis in the community and among health care providers.
Assuntos
Neoplasias do Colo do Útero , Estudos Transversais , Etiópia/epidemiologia , Feminino , Instalações de Saúde , Humanos , Estudos Prospectivos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologiaRESUMO
PURPOSE: Data comparing the burden of the opportunistic infections among the Pre-ART and On-ART HIV-infected patients in Ethiopia are scarce. Therefore, this study aimed to compare the prevalence and predictors of opportunistic infections in Pre-ART and On-ART HIV-infected patients. METHODS: A comparative cross-sectional study was conducted among adult patients infected with HIV and who were on Pre-ART or On-ART and followed up from 2012 to 2016 in Zewditu Memorial Hospital, Addis Ababa. Those patients who were infected with HIV, but not eligible for ART were categorized under Pre-ART follow-up (n=192) and those patients who started taking ART were categorized under the On-ART follow-up group (n=192). Patients were included in the study by using simple random sampling technique from the list of the patients registered in the ART follow-up database. The presence of opportunistic infections along with clinical findings and baseline laboratory data was extracted from the ART follow-up database and the medical records of the patients using a standardized checklist. Factors associated with the development of opportunistic infections were analyzed using multi-variable binary logistic regression analysis. RESULTS: The overall prevalence of opportunistic infections was found to be 33.6% (95% CI; 28.9-38.5). The prevalence of opportunistic infections among the Pre-ART group (38%) was higher than On-ART group (29.2%) (P-value = 0.04). Pulmonary tuberculosis was the most common opportunistic infection observed in both Pre-ART and On-ART groups. Being in the WHO clinical Stage III (AOR = 2.1; 95% CI 1.1-3.9) or Stage IV (AOR = 3.6; 95% CI 1.7-7.7) were independent predictors for the development of opportunistic infections. CONCLUSION: The prevalence of opportunistic infections among the HIV-infected patients who were in Pre-ART was higher than On-ART group. This finding reinforces the need for early initiation of ART for HIV-infected patients irrespective of their CD4 counts.