Tariku Dejene

The effect of household heads training on long- lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.MethodsThe study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.ResultsA total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.ConclusionHousehold level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.Trail registrationAustralian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.MethodsA cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.ResultsA total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.ConclusionTraining of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022

Determinants of non-compliance to Antiretroviral Therapy among adults living with HIV/AIDS: A Systematic Review

Background Non‐compliance with Antiretroviral Therapy is a major public health concern and further challenged by interaction of various social and clinical obstacles. So; near perfect pill taking is desirable in order to maximise its benefits. Objectives To systematically search, appraise and synthesise the best available evidence on determinants of non‐compliance with Antiretroviral Therapy among adults living with HIV/AIDS and provide direction to future how to increase compliance with Antiretroviral Therapy. Inclusion criteria Types of participants The systematic review considered studies with 18 years and above year old adults living with HIV/AIDS. Focus of the review Determinants of non‐compliance with Antiretroviral Therapy among adults living with HIV/AIDS. Types of studies Quantitative study designs were considered for inclusion. Types of outcomes Socio‐economic, Health service, Psychosocial and behavioural and Clinical related outcomes. Search strategy English language articles published between January1997 and December 2011 were sought across major databases. Methodological quality Methodological quality was assessed using Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument critical appraisal tools. Data collection Data were extracted from papers included in the review by using a standardized data extraction tool. Data synthesis Meta‐ analysis was conducted using fixed and random effects model with mantel Haenszel method using Revman5 software. Heterogeneity between the studies was assessed using &khgr;2 test at a p‐value of <0.05. Summary statistics were expressed as adjusted odds ratio or adjusted risk ratio with 95% confidence intervals at a p‐value of <0.05. Results Nine studies (seven cross‐sectional, one cohort study and one case‐control study) were included in the review. Results from meta analysis showed that white race adults living with HIV/AIDS were 1.38 times more likely to non‐comply with Antiretroviral Therapy when compared with black adults living with HIV/ AIDS (Adjusted Relative Risk=1.38; 95%CI=1.21, 1.58, p value<0.00001). Non‐depressed adults living with HIV/AIDS were 1.77 times more likely to non‐comply with Antiretroviral Therapy when compared with depressed adults living with HIV/AIDS (Adjusted Odds ratio =1.77; 95%CI=1.17, 2.69, p value=0.007). Substance non‐user adults living with HIV/ AIDS were 2.04 times more likely to non‐comply with Antiretroviral Therapy when compared with substance user adults living with HIV/ AIDS (Adjusted Relative Risk =2.04; 95%CI=1.51, 2.74, p value=<0.00001). Adults living with HIV/ AIDS with baseline CD4 count ≥200cells/ml were 1.8 times more likely to non‐comply with Antiretroviral Therapy when compared with adults livings with HIV/ AIDS with baseline CD4 count ≥200cells/ml (Adjusted Odds ratio=1.84; 95%CI=1.08, 3.15, p value=0.03). Conclusion We found the base line CD4 count ≥200cells/ml, not being depressed; not using substances and being white in race were associated with non‐compliance with Antiretroviral Therapy. Implications for practice Behavioural change via counselling should be encouraged as a way to increase compliance. Reminders to take mediations regularly, on time, offering encouragement to keep going, helping to keep clinic appointments and providing emotional support for adults living with HIV/AIDS is important. Implications for research Further research utilizing more robust experimental methods would help to further explore the findings of this review.

Are people controlling the danger or fear for condom use as HIV/AIDS preventive message? An evaluative type of study based on extended parallel process model.

Background: There almost three decade years after the first clinical cases of AIDS were reported; it has become the most devastating disease of world particplarly in developing world. Despite massive resources and intensified interventions were made in promoting condom use as prevention methods, desired decline has not been achieved. This study was aimed to evaluate how people controlling the Danger or Fear for condom use as HIV/AIDS preventive message among youths exposed to messages and the response they experience on messages. Methods: Cross-sectional study design was conducted using quantitative and qualitative methods of data collection. Pre-tested self administered questionnaires were used to collect data. Study participants were selected using stratified random sampling from hosanna public college students. Quantitative data were analyzed using SPSS version 16.0. Thematic analysis was use for qualitative data. Results: Hundred ninty one (48.1%) of the respodents were found in danger control responses, whereas 206 (51.9%) were found in fear control responses. Perceived susceptibility to and severity of HIV/AIDS was relatively high; however, perceived self efficacy and response efficacy to HIV prevention messages had lower scores. Perceived susceptibility [β (95%CI)=1.07 (1.21 to 7.10)] and severity of [β (95%CI=1.65 (1.25 to 21.81)] HIV/AIDS were positively associated factors for fear control responses. Self efficacy [β (95%CI)=-0.96 (0.16 to 0.92)] and response efficacy [β (95%CI)=-1.21 (0.11 to 0.83)] were negatively associated factors. Totally, 66.3% of the variance in the response of condom use message as HIV prevention could be explained by EPPM model. Conclusion: Despite higher numbers of students were in fear control psychological responses, there were gaps between discriminative scores and most of the current behavior. Perceived susceptiblity, severity, self efficacy and response efficacy were independent predictors of students’ perceptions to use recommended responses. Due attention should given to fill the gap of perception of both susceptibility and severity.

Khat as risk factor for hypertension: A systematic review

BACKGROUND Studies suggest possible newer risk factors for hypertension including Khat chewing, a plant which grows wild in countries bordering the Red Sea and along the east coast of Africa and the Arabian Peninsula. OBJECTIVES The objective was to synthesise the best available evidence on the epidemiological association between Khat chewing as exposure (potential risk factor) and hypertension. INCLUSION CRITERIA Subjects aged 16 years old or older regardless of gender and ethnicity, country of residence, Khat dose, frequency, duration of chewing or other characteristics of Khat exposure and co-presence of other known risk factors for hypertension.The focus of interest of this review was the epidemiological association between Khat chewing as exposure (potential risk factor) and hypertension as an outcome.Observational analytical studies (cohort studies, case-control studies and cross-sectional studies) were considered for inclusion. SEARCH STRATEGY Three staged search strategy was used to identify all relevant published and grey literature in English language from 1988 to 2011. Databases searched were PubMed, CINAHL, PopLine, LILACS, MedNar and Embase. METHODOLOGICAL QUALITY All papers selected for inclusion in the review were subjected to a rigorous, independent appraisal by the two reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION AND SYNTHESIS Due to poor internet service in our setting we were unable to use the Joanna Briggs Institute -software for data extraction and synthesis as approved in the protocol. Quantitative papers were pooled in statistical meta-analysis using the Review Manager Software. Odds ratios and their 95% confidence intervals were calculated for analysis. RESULTS Two studies from Ethiopia and one from Saudi Arabia were identified. In the study done by Getahun et al. 44 of the chewers (n=324) and 34 of the non chewers (n=319) were found to have hypertension. Analysis of this study showed no statistically significant association between Khat chewing and hypertension (OR=1.29, 95% CI =0.80-2.08). In the second study done by Mossie, 29 of the chewers (n=277) and 73 of the non chewers (n=621) were found to have hypertension and there was no statistically significant association between Khat chewing and hypertension (OR=0.88, 95% CI =0.56-1.38). Seventy seven of the chewers (n=568) and 160 of the non chewers (n=1207) were found to have hypertension) in the third study done by Ibrahim, similarly there was no statistically significant association between Khat chewing and prevalence of hypertension (OR=1.03, 95% CI =0.77-1.37 in this study.On meta analysis, a total of 3321 subjects were involved. Of the Khat chewers (1174), 150 were found to have hypertension. On contrary, 267 of non chewers (2147) were found to have hypertension. Finding of the analysis showed no statistically significant association between Khat chewing and hypertension (Odds ratio=1.04, 95% Confidence Interval= 0.84, 1.29). The studies were homogenous, Heterogeneity test: Chi = 1.35, df = 2, (P = 0.51). The test for overall effect also showed no statistical significance at conventional levels (P>0.05). CONCLUSIONS We did not find sufficient evidence to conclude that Khat as epidemiologic risk factor for hypertension.The present systematic review did not identify a statistically significant association of Khat chewing as epidemiologic risk factor for hypertension. IMPLICATIONS FOR RESEARCH This review identifies the need for further studies on Khat as an epidemiologic risk factor for hypertension considering further aspects of chewing, like dose-response, duration of chewing and co-existence of other co-morbid factors of hypertension.

Risk factors for Tuberculosis after highly active anti retro viral treatment (HAART) initiation: A systematic review

Review question/objective The objective of this review is to systematically search, appraise and synthesize the best available evidence on risk factors for developing Tuberculosis (TB) after highly active antiretroviral treatment initiation among HIV patients More specifically, the objectives are to identify: 1. The socio demographic risk factors for developing Tuberculosis after highly active anti retro viral treatment initiation 2. Clinical risk factors for developing Tuberculosis after highly active anti retroviral treatment initiation Inclusion criteria Types of participants This review will consider studies that include HIV patients who have initiated highly active anti retro viral treatment (HAART) who is above 15 years of age. Focus of the review This review will consider studies that evaluate risk factors for developing active tuberculosis among HIV patients after initiation of highly active anti retro viral treatment (HAART). Types of outcomes This review will consider studies that include socio demographic, clinical and behavioral variables as risk factors for developing tuberculosis after highly active anti retro viral treatment initiation such as but not limited to: baseline CD4 count, highly active anti retroviral treatment (HAART) type, WHO clinical stage of HIV, previous history of TB, age, gender, race.

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

BackgroundThere 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.MethodsWe 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).ResultsA 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.ConclusionsThere 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.

Effectiveness of training on standard precautions to prevent needle stick injuries among health professionals: A Systematic Review.

Review objectives The main objective of this systematic review is to critically appraise, synthesise and present the best available evidence on the effectiveness of training on standard precautions to prevent needle stick injuries among health professionals. More specifically, the objectives of this systematic review are to provide summarised evidence on: 1. The impact of standard precautions training on the frequency of needle stick injury among health professionals 2. Knowledge and practice change after training on standard precautions by health professionals 3. Needle stick injury morbidity, mortality and complications change after training on standard precautions among health professionals Inclusion criteria Types of participants This review will consider studies that include health professionals involved in clinical practices at different departments of private and governmental health institutions in both developed and developing countries. Specifically, the review will consider studies where the populations of interest are medical doctors, nurses/midwifes, auxiliary nurses, laboratory technicians, medical doctor students. There will be no restriction by age, gender or time in clinical practice among health professionals. Types of intervention The type of intervention for this systematic review will be training on standard precautions to prevent needle stick injuries among health professionals. Training in this case is the pre-service and/or in-service training given to health professionals on using and how to use protective devices to prevent needle stick injury. Comparators The comparators for this review will be health professionals who follow the standard precautions and who do not follow standard precautions. Types of outcomes The outcomes of interest for this systematic review will include: 1. Frequency of needle stick injury among health professionals 2. Knowledge and practices of standard precautions by health professionals 3. Morbidity, mortality and complications related with needle stick injury among health professionals