Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

Response to the health and nutrition needs of people affected by drought emergency in Southeast Ethiopia

Background: Without well organized preparedness, early warning system and response, the consequence of drought would be catastrophic. Objective: The objective of this study was to assess the preparedness and response of different sectors for health and nutrition needs of people affected by drought in Southeast Ethiopia. Methods: This assessment was conducted from August 14 to September 7, 2006 in Borena, Afder and Liben zones in the Southeast Ethiopia. Interview with representatives of governmental and non-governmental organizations, record review, and focus group discussion with community leaders were done to assess the health and nutrition related responses of the different stakeholders. Results: Disaster Preparedness and Prevention Commissions (DPPC) at district level did not have documented contingency planning, vulnerability assessment and risk mapping and zoning related to drought emergency. Most of the districts’ health offices had no adequate human resources to respond to drought emergency. The surveillance system was not functional in all Districts. Eighty percent of the health institutions did not conduct nutritional survey or screening. None of the health facilities had temporary or therapeutic feeding centres. Most of the focus group discussants mentioned that the food and non-food aid was not timely and adequate.Conclusions: Absence of infrastructure, lack of human resources, absence of functional surveillance system, and weakness of DPPC offices were the serious bottlenecks which affected the health and nutrition related response of the drought emergency

Determinants of acceptance of voluntary HIV testing among antenatal clinic attendees at Dil Chora Hospital, Dire Dawa, East Ethiopia

Back ground: Voluntary Counseling and Testing (VCT) is one of the best interventions to reduce mother to child transmission of HIV. Despite the proven benefits of VCT, many women are not willing to have HIV testing.Objective: The objective of this study was to identify factors that determine the acceptance of voluntary HIV testing among pregnant women attending antenatal care at Dil Chora Hospital in Dire Dawa. Method: The study employed unmatched case control study which was conducted from August 20 to September 10, 2006. The study population consisted of 234 antenatal care followers. Cases were antenatal care followers who werecounseled and tested for HIV in the current pregnancy. Controls were antenatal care followers who were counseled but not tested for HIV in the current pregnancy. Data were collected by trained enumerators using structured questionnaire. Univariate and multivariate analysis was carried out using SPSS version 12.0.1 software. Results: The majority (79.5%) of respondents (97.4% of cases and 60.5% of controls) had good knowledge on HIV, mother to child transmission and VCT. Marital status; knowledge about HIV, mother to child transmission and VCT; attitude towards VCT; antenatal care follow up and perceived benefits of VCT were independent predictors of acceptance of voluntary HIV testing. Conclusion: Knowledge on MTCT and VCT, positive attitude towards VCT, antenatal care follow-up were predictors of acceptance of VCT. During the VCT session, health professionals should focus on knowledge, attitude, and benefitsof VCT

Determinants of under-five mortality in Gilgel Gibe Field Research Center, Southwest Ethiopia

Background: In developing countries like Ethiopia where there is no vital events registration system and laboratory diagnosis is lacking, causes of death in under-five children and its determinants could not be well known. The objective of this study was to investigate causes of death and its determinants in under-five children in Gilgel Gibe Field Research Center. Methods: A case-control study was conducted from December 12 to 27, 2005. Cases of under-five children who died between August 27, 2004 and September 22, 2005 and controls of alive children with the same age (+/-2 months) as cases were identified by a survey as the study population. Data were collected by trained enumerators using structured questionnaire adopted from World Health Organization (WHO). Causes of death were determined using the expert algorithm based on verbal autopsy data. Results: Neonatal and infant mortality rates were respectively 38 and 76.4 per 1000 live births. The two most common causes of death during neonatal period were prematurity (26.4%) and pneumonia (22.6%). Whereas the top causes of death in post-neonatal period were pneumonia (42%), malaria (37%) and acute diarrheal diseases (30%). Maternal education, practice and perception of mothers on the severity of illness and benefits of modern treatment were found to be independent predictor of child survival. Conclusion: Neonatal causes, pneumonia, malaria and diarrheal diseases were the major killers of under-five children in Ethiopia. In this study, practice of mothers and perceived benefits on the modern treatment are identified as the key predictors of child survival which are amenable to future intervention.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 117-12

Incidence, prevalence and mortality rates of malaria in Ethiopia from 1990 to 2015: analysis of the global burden of diseases 2015

Background: In Ethiopia there is no complete registration system to measure disease burden and risk factors accurately. In this study, the 2015 Global Burden of Diseases, Injuries and Risk factors (GBD) data were used to analyse the incidence, prevalence and mortality rates of malaria in Ethiopia over the last 25 years. Methods: GBD 2015 used verbal autopsy (VA) surveys, reports, and published scientific articles to estimate the burden of malaria in Ethiopia. Age and gender-specific causes of death for malaria were estimated using Cause of Death Ensemble Modelling (CODEm). Results: The number of new cases of malaria declined from 2.8 million (95% uncertainty interval (UI): 1.4-4.5million) in 1990 to 621,345 (95% UI: 462,230-797,442) in 2015. Malaria caused an estimated 30,323.9 deaths (95% UI: 11,533.3-61,215.3) in 1990 and 1,561.7 deaths (95% UI: 752.8-2,660.5) in 2015, a 94.8% reduction over the 25 years. Age-standardized mortality rate of malaria has declined by 96.5% between 1990 and 2015 with an annual rate of change (ARC) of 13.4%. Age-standardized malaria incidence rate among all ages and gender declined by 88.7% between 1990 and 2015. The number of disability-adjusted life years lost (DALY) due to malaria decreased from 2.2 million (95% UI: 0.76-4.7 million) in 1990 to 0.18 million (95% UI: 0.12-0.26 million) in 2015, with a total reduction 91.7%. Similarly, age-standardized DALY rate declined by 94.8% during the same period. Conclusions: Ethiopia has achieved a 50% reduction target of malaria of the Millennium Development Goals (MDGs). The country should strengthen its malaria control and treatment strategies to achieve the Sustainable Development Goals (SDG)

Novel <i>IRF6 </i>mutations in families with Van Der Woude syndrome and popliteal pterygium syndrome from sub-Saharan Africa

Orofacial clefts (OFC) are complex genetic traits that are often classified as syndromic or nonsyndromic clefts. Currently, there are over 500 types of syndromic clefts in the Online Mendelian Inheritance in Man (OMIM) database, of which Van der Woude syndrome (VWS) is one of the most common (accounting for 2% of all OFC). Popliteal pterygium syndrome (PPS) is considered to be a more severe form of VWS. Mutations in the IRF6 gene have been reported worldwide to cause VWS and PPS. Here, we report studies of families with VWS and PPS in sub-Saharan Africa. We screened the DNA of eight families with VWS and one family with PPS from Nigeria and Ethiopia by Sanger sequencing of the most commonly affected exons in IRF6 (exons 3, 4, 7, and 9). For the VWS families, we found a novel nonsense variant in exon 4 (p.Lys66X), a novel splice-site variant in exon 4 (p.Pro126Pro), a novel missense variant in exon 4 (p.Phe230Leu), a previously reported splice-site variant in exon 7 that changes the acceptor splice site, and a known missense variant in exon 7 (p.Leu251Pro). A previously known missense variant was found in exon 4 (p.Arg84His) in the PPS family. All the mutations segregate in the families. Our data confirm the presence of IRF6-related VWS and PPS in sub-Saharan Africa and highlights the importance of screening for novel mutations in known genes when studying diverse global populations. This is important for counseling and prenatal diagnosis for high-risk families

Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study

BACKGROUND: Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia.METHODS: Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer.RESULTS: The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40-59 years), (OR= 4.7; 95%CI= 2.3-9.6), more than one husband (OR= 2.0; 95%CI=1.0-3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5-5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6-29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5-22.0) were statistically significant and the latter two were  independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of  controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done.CONCLUSION: Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral  communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.KEYWORDS: invasive cervical carcinoma, risk factors, Jimma, south west Ethiopi

Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia

Background Utilization of long-lasting insecticidal nets (LLINs) is regarded as key malaria prevention and control strategy. However, studies have reported a large gap in terms of both ownership and utilization particularly in the sub-Saharan Africa (SSA). With continual efforts to improve the use of LLIN and to progress malaria elimination, examining the factors influencing the ownership and usage of LLIN is of high importance. Therefore, the current study was conducted to examine the level of ownership and use of LLIN along with identification of associated factors at household level. Methods A cross-sectional study was conducted in Mirab Abaya District, Southern Ethiopia in June and July 2014. A total of 540 households, with an estimated 2690 members, were selected in four kebeles of the district known to have high incidence of malaria. Trained data collectors interviewed household heads to collect information on the knowledge, ownership and utilization of LLINs, which was complemented by direct observation on the conditions and use of the nets through house-to-house visit. Bivariate and multivariable logistic regression analyses were used to determine factors associated to LLIN use. Results Of 540 households intended to be included in the survey, 507 responded to the study (94.24% response rate), covering the homes of 2759 people. More than 58% of the households had family size >5 (the regional average), and 60.2% of them had at least one child below the age of 5 years. The ownership of at least one LLIN among households surveyed was 89.9%, and using at least one LLIN during the night prior to the survey among net owners was 85.1% (n = 456). Only 36.7% (186) mentioned at least as the mean of correct scores of all participants for 14 possible malaria symptoms and 32.7% (166) knew at least as the mean of correct scores of all participants for possible preventive methods. Over 30% of nets owned by the households were out of use. After controlling for confounding factors, having two or more sleeping places (adjusted odds ratio [aOR] = 2.58, 95% CI 1.17, 5.73), knowledge that LLIN prevents malaria (aOR = 2.51, 95% CI 1.17, 5.37), the presence of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and walls of the house plastered or painted >12 months ago (aOR = 0.09, 95% CI 0.01, 0.71) were important predictors of LLIN utilization. Conclusions This study found a higher proportion of LLIN ownership and utilization by households than had previously been found in similar studies in Ethiopia, and in many studies in SSA. However, poor knowledge of the transmission mechanisms and the symptoms of malaria, and vector control measures to prevent malaria were evident. Moderate proportions of nets were found to be out of use or in poor repair. Efforts should be in place to maintain the current rate of utilization of LLIN in the district and improve on the identified gaps in order to support the elimination of malaria

Association studies and direct DNA sequencing implicate some known genetic susceptibility loci in the etiology of nonsyndromic orofacial clefts in sub-Saharan African populations

Orofacial clefts (OFCs) are congenital dysmorphologies of the human face and oral cavity, with a global incidence of 1 per 700 live births. These anomalies exhibit multifactorial pattern of inheritance, with both genetic and environmental factors playing crucial roles. Many loci have been implicated in the aetiology of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in populations of Asian and European ancestries through genome-wide association studies (GWAS) and candidate gene studies. However, few populations of African descent have been studied to date. Here, we show evidence of association of some loci with NSCL/P and nonsyndromic cleft palate only (NSCPO) in cohorts from Africa (Ghana, Ethiopia and Nigeria). We genotyped 48 SNPs that were selected from previous GWAS and candidate gene studies. These markers were successfully genotyped on 701 NSCL/P and 163 NSCPO cases, 1070 unaffected relatives and 1078 unrelated controls. We also directly sequenced 7 genes in 184 nonsyndromic OFC (NSOFC) cases and 96 controls from Ghana. Population-specific associations were observed in the case-control analyses of the sub-populations, with West African subpopulations (Ghana and Nigeria) showing similar pattern of associations. In meta-analyses of the case-control cohort, PAX7 (rs742071, p=5.10×10-03), 8q24 (rs987525, p=1.22×10-03) and VAX1 (rs7078160, p=0.04) were nominally associated with NSCL/P; MSX1 (rs115200552, p=0.01), TULP4 (rs651333, p=0.04), CRISPLD2 (rs4783099, p=0.02) and NOG1 (rs17760296, p=0.04) were nominally associated with NSCPO. Moreover, 7 loci exhibited evidence of threshold over-transmission in NSOFC cases in both transmission disequilibrium test (TDT) and family-based association for disease traits (DFAM) analyses. Through DNA sequencing, we also identified two novel, rare, potentially pathogenic variants (p.Asn323Asp and p.Lys426IlefsTer6) in ARHGAP29. In conclusion, we have shown evidence of association of many loci with NSCL/P and NSCPO. To the best of our knowledge, our study is the first to demonstrate any of these association signals in any African population.<br/