Yigzaw Kebede

Two-thirds of smear-positive tuberculosis cases in the community were undiagnosed in Northwest Ethiopia: population based cross-sectional study.

Background Tuberculosis (TB) case detection rate remains low in Ethiopia. One of the underlying reasons is the emphasis on passive case finding strategy which may seriously underestimate the burden of the disease. Estimating the prevalence of smear-positive pulmonary TB through active case finding at population level can help assessing the degree to which passive case detection is successful. Methods and findings This is population based cross-sectional study. The study population was all individuals aged ≥14 years. Interviews using a uniform questionnaire were done initially to identify individuals with chronic cough (≥15 days) and the two sputum (spot and morning) samples were gathered for standard smear microscopy. A total of 23,590 individuals aged ≥14 years were interviewed and 984 had a chronic cough for ≥15 days. Of 831 individuals who provided two sputum samples for acid fast bacilli (AFB), 41 had positive smears. A total of 22 smear-positive TB cases detected through passive case finding were on anti-TB treatment. The prevalence of new smear-positive TB was 174 per 100,000 in persons aged ≥14 years (95% CI: 121–227).The ratio of active to passive case finding was 2∶1. Higher rates of smear-positivity were observed among females [AOR: 3.28, 95% CI (1.54–6.77)], and in the age group ≥45 years [AOR: 2.26, 95% CI (1.12–4.59). Conclusions The study revealed that about two-thirds of patients with active TB remain undiagnosed and thus untreated. This may indicate the need for strengthening case detection at the community level. Furthermore, the high burden of TB among females and in the age group ≥45 years warrants appropriate measures to control the disease.

Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study.

BackgroundTimely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control program. However, studies to understand patents’ perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. The aim of this study is to attempt to do that in rural Ethiopia.MethodsThis qualitative, phenomenological study conducted 26 in-depth interviews with tuberculosis patients. A thematic content analysis of the interviews was performed using the Open Code software version 3.1.ResultsWe found that lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments.ConclusionsThis study highlighted complexities surrounding tuberculosis control efforts in Dabat District. Challenges of geographic access to health care facilities and financial burdens were factors that most influenced timely tuberculosis treatment initiation and compliance. Decentralization of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.

Predictors of perinatal mortality in rural population of Northwest Ethiopia: a prospective longitudinal study

BackgroundPerinatal mortality is one of the serious challenges in meeting maternal and child Millennium Development Goals in developing countries. Identifying its predictors is an important step to develop focused and appropriate health interventions for reducing perinatal deaths. This study therefore aims at identifying predictors of perinatal mortality in a rural setting in northwest Ethiopia.MethodsA prospective longitudinal study was conducted at Dabat Health and Demographic Surveillance site, northwest Ethiopia, from November 2009 to August 2011. Data were collected by interviewing the mothers or guardians of eligible children. Multiple logistic regressions were employed to identify potential predictors.ResultsA total of 1752 eligible children were included in the study. Perinatal mortality rate in the study population was 50.22 per 1000 (95% CI: 39.99, 60.46) total births. In multiple logistic analysis, previous still birth [(AOR = 8.38, 95% CI: 3.94, 17.83)], twin birth [(AOR = 7.09, 95% CI: (3.22, 15.61)], not receiving tetanus toxoid vaccine during the index pregnancy [(AOR = 3.62, 95% CI: 1.57, 8.34)], short birth interval of less than 24 months [(AOR = 2.58, 95% CI: (1.61, 4.13)], maternal illiteracy [(AOR = 4.83, 95% CI: (1.45, 16.05)] and mothers’ running own business [(AOR = 5.40, 95% CI: 1.40, 27.96)] were the main predictors associated with increased risk of perinatal death.ConclusionsPredictors of perinatal death in the study area are easily recognizable and potentially preventable with the existing maternal health programs. Efforts need to be intensified in expanding maternal and newborn health services to significantly reduce perinatal mortality in rural settings.

Assessing and understanding quality of care in a labour ward: a pilot study combining clinical and social science perspectives in Gondar Ethiopia.

Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources. The discussion focuses on implications for informing quality improvement interventions. Improvements will need to address health systems issues, such as supply of key drugs, as well as changes in professional practice to promote the rational use of drugs. Furthermore, the study considers the need to understand broader organizational factors and inter-professional relationships. The potential for greater integration of social science perspectives as part of currently increasing monitoring and evaluation activity around intrapartum care is highlighted.

Death and seeking alternative therapy largely accounted for lost to follow-up of patients on ART in northwest Ethiopia: a community tracking survey.

Background Antiretroviral treatment programs in sub-Saharan African countries are highly affected by LTF. Tracking patients lost to follow-up and understanding their status is essential to maintain program quality and to develop targeted interventions to prevent LTF. We aimed to determine the outcome and factors associated with LTF. Method A lost to follow-up community tracking survey was conducted to determine the reasons, outcomes and factors associated with LTF at the University of Gondar Hospital, northwest Ethiopia. All patients were tracked at home to ascertain outcome status for lost to follow-up (death and non-death losses). Result Out of the 551 patients LTF, 486 (88.20%) were successfully tracked. Death was the most common reason accounted for 233 (47.94%) of the lost to follow-up. Reasons for non-deaths losses include: stopped antiretroviral treatment due to different reasons, 135(53.36%), and relocation to another antiretroviral treatment program by self- transfer, 118(46.64%). The rate of mortality in the first six months was 72.12 per 100 person-years (95% CI: 61.80–84.24) but this sharply decreased after 12 months to 7.92 per 100 person-years (95% CI: 4.44–14.41). Baseline clinical characteristics were strongly associated with mortality. Conclusion Death accounts for about half of the loss to follow up. Most deaths occur in the first six months of loss. Seeking alternative therapy is another major reason for loss to follow up. Early tracking mechanisms are necessary to prevent death.

Knowledge and utilization of information communication technology (ICT) among health science students at the University of Gondar, North Western Ethiopia.

BackgroundDespite the relatively huge ICT investment and policy deployment in higher institutions in Ethiopia, there is still scant information about the success of implementation of the Information Communication Technology (ICT) in the higher education. This study, therefore, was carried out with an aim to assess knowledge and utilization of Information Communication Technology (ICT) among medicine and health science students and its associated factors in Gondar College of Medicine and Health sciences, University of Gondar.MethodsA cross-sectional study was conducted at the College of Medicine and Health Sciences, University of Gondar, Ethiopia. Data regarding socio-demographic characteristics of the students, level of knowledge and utilization of ICT were collected by means of a self-administered questionnaire. Data was analyzed using SPSS version 13.ResultsA total of 1096 students responded giving a response rate of 97.8%. The mean age of the study participants was 20.3 (±1. 3) years. Females constitute only 26% of the respondents. The majority (79%) were fulltime students. Only half of the respondents (51%) had ICT knowledge and only 46% students utilized ICT while 47% of the respondents never used electronic communication (e.g. email or chat room) and 39% of the respondents never used Microsoft office (e.g. word ® or WordPerfect ®). ICT knowledge [AOR = 2.5, 95% CI: 1.7-3.5], family educational background [AOR = 4.36, 95% CI: 2.16-8.80], and perceived quality of training [AOR = 1.9, 95% CI: 1.3-2.8] showed strong and positive associations with ICT utilization. Students from urban areas were more likely to utilize ICT compared with those from rural areas [AOR = 2.7, 95% CI: 2.097, 3.497], and information technology training was found to be positively associated with ICT utilization [AOR = 2. 07, 95% CI: 1.18, 3.62].ConclusionsThe result showed that students’ knowledge was inadequate and utilization of ICT was poor. Therefore, the university should sustain professional development to improve teaching, to raise student performance and equip the college with student centered ICT computer labs to increase students’ ICT utilization.

High Loss to Followup and Early Mortality Create Substantial Reduction in Patient Retention at Antiretroviral Treatment Program in North-West Ethiopia

Background. There has been a rapid scale up of antiretroviral therapy (ART) in Ethiopia since 2005. We aimed to evaluate mortality, loss to followup, and retention in care at HIV Clinic, University of Gondar Hospital, north-west Ethiopia. Method. A retrospective patient chart record analysis was performed on adult AIDS patients enrolled in the treatment program starting from 1 March 2005. We performed survival analysis to determine, mortality, loss to followup and retention in care. Results. A total of 3012 AIDS patients were enrolled in the ART Program between March 2005 and August 2010. At the end of the 66 months of the program initiation, 61.4% of the patients were retained on treatment, 10.4% died, and 31.4% were lost to followup. Fifty-six percent of the deaths and 46% of those lost to followup occurred in the first year of treatment. Male gender (adjusted hazard ratio (AHR) was 3.26; 95% CI: 2.19–4.88); CD4 count ≤200 cells/μL (AHR 5.02; 95% CI: 2.03–12.39), tuberculosis (AHR 2.91; 95% CI: 2.11–4.02); bed-ridden functional status (AHR 12.88; 95% CI: 8.19–20.26) were predictors of mortality, whereas only CD4 count <200 cells/μL (HR = 1.33; 95% CI: (0.95, 1.88) and ambulatory functional status (HR = 1.65; 95% CI: (1.22, 2.23) were significantly associated with LTF. Conclusion. Loss to followup and mortality in the first year following enrollment remain a challenge for retention of patients in care. Strengthening patient monitoring can improve patient retention AIDS care.

Factors Associated with Anemia among Children Aged 6–23 Months Attending Growth Monitoring at Tsitsika Health Center, Wag-Himra Zone, Northeast Ethiopia

Background. Globally, about 47.4% of children under five are suffering from anemia. In Ethiopia, 60.9% of children under two years are suffering from anemia. Anemia during infancy and young childhood period is associated with poor health and impaired cognitive development, leading to reduced academic achievement and earnings potential in their adulthood life. However, there is scarcity of information showing the magnitude of iron deficiency anemia among young children in Ethiopia. Therefore, this study aimed at assessing prevalence and associated factors of iron deficiency anemia among children under two (6–23 months). Methods. Institution based cross-sectional study was carried out from March to May, 2014, at Tsitsika Health Center in Wag-Himra Zone, Northeast Ethiopia. Systematic random sampling technique was employed. Automated hemoglobin machine was used to determine the hemoglobin level. Socioeconomic and demographic data were collected by using a pretested and structured questionnaire. Binary logistic regression analysis was used to identify associated factors and odds ratio with 95% CI was computed to assess the strength of association. Results. Total of 347 children participated in this study. The overall prevalence of anemia was 66.6%. In multivariate logistic regression analysis, male sex (AOR = 3.1 (95% CI: 1.60–5.81)), 9–11 months of age (AOR = 9.6 (95% CI: 3.61–25.47)), poor dietary diversity (AOR = 3.2 (95% CI: 1.35–7.38)), stunting (AOR = 2.7 (95% CI: 1.20–6.05)), diarrhea (AOR = 4.9 (1.63–14.59)), no formal education (AOR = 2.6 (95% CI: 1.26–5.27)), early initiation of complementary food (AOR = 11.1 (95% CI: 4.08–30.31)), and lowest wealth quintile (AOR = 3.0 (95% CI: 1.01–8.88)) were significantly associated with anemia. Conclusion. The overall prevalence of anemia among children who aged 6–23 months has sever public health importance in the study area. Integrated efforts need to be prioritized to improve health as well as appropriate infant and young child feeding practice among children under.

The Clustering of Smear-Positive Tuberculosis in Dabat, Ethiopia: A Population Based Cross Sectional Study

Background In Ethiopia where tuberculosis epidemic remains high, studies that describe hotspots of the disease are unavailable. This study tried to detect the spatial distribution and clustering of smear-positive tuberculosis cases in Dabat, Ethiopia. Methods and Findings A population-based cross sectional study conducted in the Dabat Health and Demographic Surveillance System site from October 2010 to September 2011 identified smear-positive tuberculosis cases. Trained field workers collected demographic and location data from each study participant through house-to-house visits. A spatial scan statistic was used to identify purely spatial and space–time clusters of tuberculosis among permanent residents. Two significant (p<0.001) spatial and space-time clusters were identified in the study district. Conclusion Tuberculosis is concentrated in certain geographic locations in Dabat, Ethiopia. This kind of clustering can be common in the country, so the National Tuberculosis Control Program can be more effective by identifying such clusters and targeting interventions.

Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia

OBJECTIVE To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia. METHODS Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy. RESULTS A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12). CONCLUSION The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.