Publications by authors named "Amare Deribew"

62 Publications

Determinants of Anemia Among Children Aged 6 to 59 Months in Dilla Town, Southern Ethiopia: A Facility Based Case Control Study.

Glob Pediatr Health 2020 20;7:2333794X20974232. Epub 2020 Nov 20.

St.Paul Milliennium Medical College, Addis Abeba, Ethiopia.

Globally, anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Under 5 children have greater risk of anemia. The level of burden and the risk factors for anemia vary in different settings. Identifying local factors will have important implications for health intervention programs aimed to tackle the burden. Our study aims to investigate the determinants of anemia among under 5 children in the study area. Facility based unmatched case control study was conducted among 413 (137 cases and 276 controls) children of Dilla town. Cases were children who had hemoglobin level of less than 11 g/dl and controls were children aged 6 to 59 months with hemoglobin ≥11 g/dl. Quota and simple random sampling was used for cases and controls respectively. Data on socio-demographic, dietary diversity score, food security, anthropometry, hemoglobin level, malaria infection and intestinal parasites were collected. Data were analyzed with SPSS version 25. Bi-variate and multivariate binary logistic regression analysis was used to identify independent determinants of anemia. -value less than .05 were used to declare statistical significance. In the multivariate analysis, having more than 1 under 5 children in the households (AOR = 3.03, 95%CI = 1.35-6.81), intestinal parasitosis (AOR = 4.42, 95%CI = 2.07-9.44), food insecurity (AOR = 2.75, 95% CI = 1.39-5.45), and stunting (AOR = 6.09, 95% CI = 2.53-14.67) were determinants of anemia among children aged 6 to 59 months. Some of the identified factors are modifiable that could be targeted to reduce childhood anemia. Family planning education, provision of anti-helminthic drugs and ensuring household food security will be beneficial to tackle anemia.
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http://dx.doi.org/10.1177/2333794X20974232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683845PMC
November 2020

Health system capacity for tuberculosis care in Ethiopia: evidence from national representative survey.

Int J Qual Health Care 2020 Jun;32(5):306-312

Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.

Objective: The objective of this study was to evaluate the tuberculosis (TB) health system capacity and its variations by location and types of health facilities in Ethiopia.

Design: We used the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all hospitals and randomly selected health centers and private facilities in all regions of Ethiopia. We assessed structural, process and overall health system capacity based on the Donabedian quality of care model. Multiple linear regression and spatial analysis were done to assess TB capacity score variation across regions.

Setting: The study included 873 public and private health facilities all over Ethiopia.

Participants: None.

Intervention(s): None.

Main Outcome Measure(s): None.

Results: A total of 873 health facilities were included in the analysis. The overall TB care capacity score was 76.7%, 55.9% and 37.8% in public hospitals, health centers and private facilities, respectively. The health system capacity score for TB was higher in the urban (60.4%) facilities compared to that of the rural (50.0%) facilities (β = 8.0, 95% CI: 4.4, 11.6). Health centers (β = -16.2, 95% CI: -20.0, -12.3) and private health facilities (β = -38.3, 95% CI: -42.4, -35.1) had lower TB care capacity score than hospitals. Overall TB care capacity score were lower in Western and Southwestern Ethiopia and in Benishangul-Gumuz and Gambella regions.

Conclusions: The health system capacity score for TB care in Ethiopia varied across regions. Health system capacity improvement interventions should focus on the private sectors and health facilities in the rural and remote areas to ensure equity and improve quality of care.
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http://dx.doi.org/10.1093/intqhc/mzaa024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299195PMC
June 2020

Measuring the spatial heterogeneity on the reduction of vaginal fistula burden in Ethiopia between 2005 and 2016.

Sci Rep 2020 01 22;10(1):972. Epub 2020 Jan 22.

Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.

Vaginal fistula is a shattering maternal complication characterized by an anomalous opening between the bladder and/or rectum and vagina resulting in continuous leakage of urine or stool. Although prevalent in Ethiopia, its magnitude and distribution is not well studied. We used statistical mapping models using 2005 and 2016 Ethiopia Demographic Health Surveys data combined with a suite of potential risk factors to estimate the burden of vaginal fistula among women of childbearing age. The estimated number of women of childbearing age with lifetime and untreated vaginal fistula in 2016 were 72,533 (95% CI 38,235-124,103) and 31,961 (95% CI 11,596-70,309) respectively. These figures show reduction from the 2005 estimates: 98,098 (95% CI 49,819-170,737) lifetime and 59,114 (95% CI 26,580-118,158) untreated cases of vaginal fistula. The number of districts having more than 200 untreated cases declined drastically from 54 in 2005 to 6 in 2016. Our results show a significant subnational variation in the burden of vaginal fistula. Overall, between 2005 and 2016 there was substantial reduction in the prevalence of vaginal fistula in Ethiopia. Our results help guide local level tracking, planning, spatial targeting of resources and implementation of interventions against vaginal fistula.
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http://dx.doi.org/10.1038/s41598-020-58036-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976656PMC
January 2020

The Burden of HIV/AIDS in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study.

Ethiop J Health Sci 2019 Jan;29(1):859-868

Institute of Health Metrics and Evaluation, University of Washington.

Background: The burden of HIV/AIDS in Ethiopia has not been comprehensively assessed over the last two decades. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk factors (GBD) data to analyze the incidence, prevalence, mortality and Disability-adjusted Life Years Lost (DALY) rates of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) in Ethiopia over the last 26 years.

Methods: The GBD 2016 used a wide range of data source for Ethiopia such as verbal autopsy (VA), surveys, reports of the Federal Ministry of Health and the United Nations (UN) and published scientific articles. The modified United Nations Programme on HIV/AIDS (UNAIDS) Spectrum model was used to estimate the incidence and mortality rates for HIV/AIDS.

Results: In 2016, an estimated 36,990 new HIV infections (95% uncertainty interval [UI]: 8775-80262), 670,906 prevalent HIV cases (95% UI: 568,268-798,970) and 19,999 HIV deaths (95% UI: 16426-24412) occurred in Ethiopia. The HIV/AIDS incidence rate peaked in 1995 and declined by 6.3% annually for both sexes with a total reduction of 77% between 1990 and 2016. The annualized HIV/AIDS mortality rate reduction during 1990 to 2016 for both sexes was 0.4%.

Conclusions: Ethiopia has achieved the 50% reduction of the incidence rate of HIV/AIDS based on the Millennium Development Goals (MDGs) target. However, the decline in HIV/AIDS mortality rate has been comparatively slow. The country should strengthen the HIV/AIDS detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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http://dx.doi.org/10.4314/ejhs.v29i1.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341438PMC
January 2019

Good governance, public health expenditures, urbanization and child undernutrition Nexus in Ethiopia: an ecological analysis.

BMC Health Serv Res 2019 Jan 15;19(1):40. Epub 2019 Jan 15.

International Medical Corps, Country Office, Khartoum, Sudan.

Background: Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia.

Methods: This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations' World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition.

Result: Government effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition.

Conclusion: This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.
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http://dx.doi.org/10.1186/s12913-018-3822-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334413PMC
January 2019

Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study.

Ethiop J Health Sci 2018 Sep;28(5):519-528

World Health Organization, Uganda.

Background: The burden of Tuberculosis (TB) has not been comprehensively evaluated over the last 25 years in Ethiopia. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD) data to analyze the incidence, prevalence and mortality rates of tuberculosis (TB) in Ethiopia over the last 26 years.

Methods: The GBD 2016 is a mathematical modeling using different data source for Ethiopia such as verbal autopsy (VA), prevalence surveys and annual case notifications. Age and sex specific causes of death for TB were estimated using the Cause of Death Ensemble Modeling (CODEm). We used the available data such as annual notifications and prevalence surveys as an input to estimate incidence and prevalence rates respectively using DisMod-MR 2.1, a Bayesian meta-regression tool.

Results: In 2016, we estimated 219,186 (95%UI: 182,977-265,292) new, 151,602 (95% UI: 126,054-180,976) prevalent TB cases and 48,910(95% UI: 40,310-58,195) TB deaths. The age-standardized TB incidence rate decreased from 201.6/100,000 to 88.5/100,000 (with a total decline of 56%) between 1990 to 2016. Similarly, the age-standardized TB mortality rate declined from 393.8/100,000 to 100/100,000 between 1990 and 2016(with a total decline of 75%).

Conclusions: Ethiopia has achieved the 50% reduction of most of the Millennium Development Goals (MDGs) targets related to TB. However, the decline of TB incidence and prevalence rates has been comparatively slow. The country should strengthen the TB case detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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http://dx.doi.org/10.4314/ejhs.v28i5.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308773PMC
September 2018

Is deployment of trained nurses to rural villages a remedy for the low skilled birth attendance in Ethiopia? A cluster randomized-controlled community trial.

PLoS One 2018 12;13(10):e0204986. Epub 2018 Oct 12.

St. Paul Millennium Medical College, Addis Ababa, Ethiopia.

Background: Low coverage of Skilled Birth Attendance (SBA) is one of the major drivers of maternal mortality in many low- and middle-income countries (LMICs) including Ethiopia. We conducted a cluster-randomized controlled community trial to assess the effect of deploying trained community based nurses to rural communities on the uptake levels of SBA in Ethiopia.

Methods: A three-arm, parallel groups, cluster-randomized community trial was conducted to assess the effect of deploying trained community based reproductive health nurses (CORN) on the uptake of SBA services. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where these new service providers were deployed, a health post (HP) or health center (HC). Baseline and end line surveys were conducted to document and measure the effects of the intervention. Program impacts on SBA coverage were calculated using difference-in-difference (DID) analysis.

Results: After nine months of intervention, the coverage of SBA services increased significantly by 81.1% (from 24.61 to 44.59) in the HP based intervention arm, and by 122.9% (from 16.41 to 36.59) in the HC arm, respectively (p <0.01). Conversely, a small and non-significant (2%) decline in SBA coverage were observed in the control arm (P >0.05). The DID estimate indicated a net increase in SBA coverage of 21.32 and 20.52 percentage points (PP) across the HP and HC based intervention arms, respectively (p < 0.001).

Conclusions: Deployment of trained reproductive health nurses to rural communities in Ethiopia significantly improved utilization of SBA services. Therefore; in similar low income settings where coverage of SBA services is very low, deployment of trained community based nurses to grassroots level could potentiate rapid service uptake. Additional cost-effectiveness and validation studies at various setups are required, before scale-up of the innovation, however.

Trial Registration: clinicaltrails.gov NCT02501252.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204986PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193577PMC
March 2019

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

BMC Health Serv Res 2018 07 11;18(1):535. Epub 2018 Jul 11.

Center for Population Studies, Addis Ababa University, Addis Ababa, 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.
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http://dx.doi.org/10.1186/s12913-018-3347-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042210PMC
July 2018

Burden of disease attributable to suboptimal diet, metabolic risks and low physical activity in Ethiopia and comparison with Eastern sub-Saharan African countries, 1990-2015: findings from the Global Burden of Disease Study 2015.

BMC Public Health 2018 04 25;18(1):552. Epub 2018 Apr 25.

Nutrition International, Addis Ababa, Ethiopia.

Background: Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries.

Methods: Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models.

Results: In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653-76,020] or 8.9% [95% UI: 6.1-12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367-106,512] or 9.7% [95% UI: 7.4-12.3] to dietary risks, 105,057 [95% UI: 66,167-157,071] or 15.4% [95% UI: 12.8-17.6] to metabolic risks and 5808 [95% UI: 3449-9359] or 0.9% [95% UI: 0.6-1.1] to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8-13.3] to 14.5% [95% UI: 11.7-18.0] for dietary risks and from 17.0% [95% UI: 15.4-18.7] to 24.2% [95% UI: 22.2-26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary and metabolic risks.

Conclusions: In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of the country.
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http://dx.doi.org/10.1186/s12889-018-5438-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922000PMC
April 2018

CLINICAL ASSESSMENT OF CARDIOVASCULAR DISEASE ASSOCIATED RISK FACTORS IN JIMMATOWN, SOUTHWEST ETHIOPIA; A COMMUNITY BASED CROSS – SECTIONAL STUDY.

Ethiop Med J 2017 Jan;55(1):3-9

Introduction: Cardiovascular disease has been identified as emerging epidemic in developing world and Sub-saharan Africa. The prevalence of risk factors associated with cardiovascular disease is not clearly established in our country. We conducted this study to determine the prevalence of cardiovascular disease associated risk factors in Jimma town.

Methods: A cross-sectional study was conducted in sampled adults in Jimma town. Multi-stage sampling was used by combining simple random sampling to select kebeles of Jimma town and then systematic random sampling to select the house hold .An individual was selected with a lottery method if there were more than one adult in the house hold who fulfills inclusion criteria. Data were collected using the World Health Organization standardized structured questionnaire on cardiovascular risk assessment for developing countries. The study variables included anthropometric measurements, demographic information and behavioral risk factors. The data variables were computed using SPSS version 20.

Results: Majority (70.9%) of the respondents have one or more of the seven cardiovascular disease risk factors assessed. Nearly one forth (23.8%) of the study participants were hypertensive, 6.2% were known diabetes and the prevalence of smoking was 11.8% among males 2% among females. The prevalence of overweight/obesity was 26.8 %.

Conclusion: Majority were found to have at least one of the risk factors for cardiovascular disease. Hypertension and diabetes mellitus were the most common. Screening programs, health education and awareness creation are recommended to prevent the development of the disease. Large scale prospective study with laboratory data will help to further analyze and strengthen the results for policy makers.
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January 2017

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

Popul Health Metr 2017 21;15:29. Epub 2017 Jul 21.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.

Background: Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years.

Methods: GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015.

Results: CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015.

Conclusions: Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.
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http://dx.doi.org/10.1186/s12963-017-0145-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521057PMC
June 2018

National disability-adjusted life years (DALYs) for 257 diseases and injuries in Ethiopia, 1990-2015: findings from the global burden of disease study 2015.

Popul Health Metr 2017 07 21;15(1):28. Epub 2017 Jul 21.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.

Background: Disability-adjusted life years (DALYs) provide a summary measure of health and can be a critical input to guide health systems, investments, and priority-setting in Ethiopia. We aimed to determine the leading causes of premature mortality and disability using DALYs and describe the relative burden of disease and injuries in Ethiopia.

Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for non-fatal disease burden, cause-specific mortality, and all-cause mortality to derive age-standardized DALYs by sex for Ethiopia for each year. We calculated DALYs by summing years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) for each age group and sex. Causes of death by age, sex, and year were measured mainly using Causes of Death Ensemble modeling. To estimate YLDs, a Bayesian meta-regression method was used. We reported DALY rates per 100,000 for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases, and injuries, with 95% uncertainty intervals (UI) for Ethiopia.

Results: Non-communicable diseases caused 23,118.1 (95% UI, 17,124.4-30,579.6), CMNN disorders resulted in 20,200.7 (95% UI, 16,532.2-24,917.9), and injuries caused 3781 (95% UI, 2642.9-5500.6) age-standardized DALYs per 100,000 in Ethiopia in 2015. Lower respiratory infections, diarrheal diseases, and tuberculosis were the top three leading causes of DALYs in 2015, accounting for 2998 (95% UI, 2173.7-4029), 2592.5 (95% UI, 1850.7-3495.1), and 2562.9 (95% UI, 1466.1-4220.7) DALYs per 100,000, respectively. Ischemic heart disease and cerebrovascular disease were the fourth and fifth leading causes of age-standardized DALYs, with rates of 2535.7 (95% UI, 1603.7-3843.2) and 2159.9 (95% UI, 1369.7-3216.3) per 100,000, respectively. The following causes showed a reduction of 60% or more over the last 25 years: lower respiratory infections, diarrheal diseases, tuberculosis, neonatal encephalopathy, preterm birth complications, meningitis, malaria, protein-energy malnutrition, iron-deficiency anemia, measles, war and legal intervention, and maternal hemorrhage.

Conclusions: Ethiopia has been successful in reducing age-standardized DALYs related to most communicable, maternal, neonatal, and nutritional deficiency diseases in the last 25 years, causing a major ranking shift to types of non-communicable disease. Lower respiratory infections, diarrheal disease, and tuberculosis continue to be leading causes of premature death, despite major declines in burden. Non-communicable diseases also showed reductions as premature mortality declined; however, disability outcomes for these causes did not show declines. Recently developed non-communicable disease strategies may need to be amended to focus on cardiovascular diseases, cancer, diabetes, and major depressive disorders. Increasing trends of disabilities due to neonatal encephalopathy, preterm birth complications, and neonatal disorders should be emphasized in the national newborn survival strategy. Generating quality data should be a priority through the development of new initiatives such as vital events registration, surveillance programs, and surveys to address gaps in data. Measuring disease burden at subnational regional state levels and identifying variations with urban and rural population health should be conducted to support health policy in Ethiopia.
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http://dx.doi.org/10.1186/s12963-017-0146-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521136PMC
July 2017

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

Malar J 2017 07 4;16(1):271. Epub 2017 Jul 4.

Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.

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 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.

Results: The number of new cases of malaria declined from 2.8 million [95% uncertainty interval (UI) 1.4-4.5 million] in 1990 to 621,345 (95% UI 462,230-797,442) in 2015. Malaria caused an estimated 30,323 deaths (95% UI 11,533.3-61,215.3) in 1990 and 1561 deaths (95% UI 752.8-2660.5) 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 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. The country should strengthen its malaria control and treatment strategies to achieve the sustainable development goals.
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http://dx.doi.org/10.1186/s12936-017-1919-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496144PMC
July 2017

Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.

Authors:
Nicholas Kassebaum Hmwe Hmwe Kyu Leo Zoeckler Helen Elizabeth Olsen Katie Thomas Christine Pinho Zulfiqar A Bhutta Lalit Dandona Alize Ferrari Tsegaye Tewelde Ghiwot Simon I Hay Yohannes Kinfu Xiaofeng Liang Alan Lopez Deborah Carvalho Malta Ali H Mokdad Mohsen Naghavi George C Patton Joshua Salomon Benn Sartorius Roman Topor-Madry Stein Emil Vollset Andrea Werdecker Harvey A Whiteford Kalkidan Hasen Abate Kaja Abbas Solomon Abrha Damtew Muktar Beshir Ahmed Nadia Akseer Rajaa Al-Raddadi Mulubirhan Assefa Alemayohu Khalid Altirkawi Amanuel Alemu Abajobir Azmeraw T Amare Carl A T Antonio Johan Arnlov Al Artaman Hamid Asayesh Euripide Frinel G Arthur Avokpaho Ashish Awasthi Beatriz Paulina Ayala Quintanilla Umar Bacha Balem Demtsu Betsu Aleksandra Barac Till Winfried Bärnighausen Estifanos Baye Neeraj Bedi Isabela M Bensenor Adugnaw Berhane Eduardo Bernabe Oscar Alberto Bernal Addisu Shunu Beyene Sibhatu Biadgilign Boris Bikbov Cheryl Anne Boyce Alexandra Brazinova Gessessew Bugssa Hailu Austin Carter Carlos A Castañeda-Orjuela Ferrán Catalá-López Fiona J Charlson Abdulaal A Chitheer Jee-Young Jasmine Choi Liliana G Ciobanu John Crump Rakhi Dandona Robert P Dellavalle Amare Deribew Gabrielle deVeber Daniel Dicker Eric L Ding Manisha Dubey Amanuel Yesuf Endries Holly E Erskine Emerito Jose Aquino Faraon Andre Faro Farshad Farzadfar Joao C Fernandes Daniel Obadare Fijabi Christina Fitzmaurice Thomas D Fleming Luisa Sorio Flor Kyle J Foreman Richard C Franklin Maya S Fraser Joseph J Frostad Nancy Fullman Gebremedhin Berhe Gebregergs Alemseged Aregay Gebru Johanna M Geleijnse Katherine B Gibney Mahari Gidey Yihdego Ibrahim Abdelmageem Mohamed Ginawi Melkamu Dedefo Gishu Tessema Assefa Gizachew Elizabeth Glaser Audra L Gold Ellen Goldberg Philimon Gona Atsushi Goto Harish Chander Gugnani Guohong Jiang Rajeev Gupta Fisaha Haile Tesfay Graeme J Hankey Rasmus Havmoeller Martha Hijar Masako Horino H Dean Hosgood Guoqing Hu Kathryn H Jacobsen Mihajlo B Jakovljevic Sudha P Jayaraman Vivekanand Jha Tariku Jibat Catherine O Johnson Jost Jonas Amir Kasaeian Norito Kawakami Peter N Keiyoro Ibrahim Khalil Young-Ho Khang Jagdish Khubchandani Aliasghar A Ahmad Kiadaliri Christian Kieling Daniel Kim Niranjan Kissoon Luke D Knibbs Ai Koyanagi Kristopher J Krohn Barthelemy Kuate Defo Burcu Kucuk Bicer Rachel Kulikoff G Anil Kumar Dharmesh Kumar Lal Hilton Y Lam Heidi J Larson Anders Larsson Dennis Odai Laryea Janni Leung Stephen S Lim Loon-Tzian Lo Warren D Lo Katharine J Looker Paulo A Lotufo Hassan Magdy Abd El Razek Reza Malekzadeh Desalegn Markos Shifti Mohsen Mazidi Peter A Meaney Kidanu Gebremariam Meles Peter Memiah Walter Mendoza Mubarek Abera Mengistie Gebremichael Welday Mengistu George A Mensah Ted R Miller Charles Mock Alireza Mohammadi Shafiu Mohammed Lorenzo Monasta Ulrich Mueller Chie Nagata Aliya Naheed Grant Nguyen Quyen Le Nguyen Elaine Nsoesie In-Hwan Oh Anselm Okoro Jacob Olusegun Olusanya Bolajoko O Olusanya Alberto Ortiz Deepak Paudel David M Pereira Norberto Perico Max Petzold Michael Robert Phillips Guilherme V Polanczyk Farshad Pourmalek Mostafa Qorbani Anwar Rafay Vafa Rahimi-Movaghar Mahfuzar Rahman Rajesh Kumar Rai Usha Ram Zane Rankin Giuseppe Remuzzi Andre M N Renzaho Hirbo Shore Roba David Rojas-Rueda Luca Ronfani Rajesh Sagar Juan Ramon Sanabria Muktar Sano Kedir Mohammed Itamar S Santos Maheswar Satpathy Monika Sawhney Ben Schöttker David C Schwebel James G Scott Sadaf G Sepanlou Amira Shaheen Masood Ali Shaikh June She Rahman Shiri Ivy Shiue Inga Dora Sigfusdottir Jasvinder Singh Naris Silpakit Alison Smith Chandrashekhar Sreeramareddy Jeffrey D Stanaway Dan J Stein Caitlyn Steiner Muawiyyah Babale Sufiyan Soumya Swaminathan Rafael Tabarés-Seisdedos Karen M Tabb Fentaw Tadese Mohammad Tavakkoli Bineyam Taye Stephanie Teeple Teketo Kassaw Tegegne Girma Temam Shifa Abdullah Sulieman Terkawi Bernadette Thomas Alan J Thomson Ruoyan Tobe-Gai Marcello Tonelli Bach Xuan Tran Christopher Troeger Kingsley N Ukwaja Olalekan Uthman Tommi Vasankari Narayanaswamy Venketasubramanian Vasiliy Victorovich Vlassov Elisabete Weiderpass Robert Weintraub Solomon Weldemariam Gebrehiwot Ronny Westerman Hywel C Williams Charles D A Wolfe Rachel Woodbrook Yuichiro Yano Naohiro Yonemoto Seok-Jun Yoon Mustafa Z Younis Chuanhua Yu Maysaa El Sayed Zaki Elias Asfaw Zegeye Liesl Joanna Zuhlke Christopher J L Murray Theo Vos

JAMA Pediatr 2017 06;171(6):573-592

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions And Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
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http://dx.doi.org/10.1001/jamapediatrics.2017.0250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540012PMC
June 2017

Trends and causes of maternal mortality in Ethiopia during 1990-2013: findings from the Global Burden of Diseases study 2013.

BMC Public Health 2017 02 2;17(1):160. Epub 2017 Feb 2.

Population KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.

Background: Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013.

Methods: We used the Global Burden of Diseases and Risk factors (GBD) Study 2013 data that was collected from multiple sources at national and subnational levels. Spatio-temporal Gaussian Process Regression (ST-GPR) was applied to generate best estimates of maternal mortality with 95% Uncertainty Intervals (UI). Causes of death were measured using Cause of Death Ensemble modelling (CODEm). The modified UNAIDS EPP/SPECTRUM suite model was used to estimate HIV related maternal deaths.

Results: In Ethiopia, a total of 16,740 (95% UI: 14,197, 19,271) maternal deaths occurred in 1990 whereas there were 15,234 (95% UI: 11,378, 19,871) maternal deaths occurred in 2013. This finding shows that Maternal Mortality Ratio (MMR) in Ethiopia was still high in the study period. There was a minimal but insignificant change of MMR over the last 23 years. The results revealed Ethiopia is below the target of Millennium Development Goals (MGDs) related to MMR. The top five causes of maternal mortality in 2013 were other direct maternal causes such as complications of anaesthesia, embolism (air, amniotic fluid, and blood clot), and the condition of peripartum cardiomyopathy (25.7%), complications of abortions (19.6%), maternal haemorrhage (12.2%), hypertensive disorders (10.3%), and maternal sepsis and other maternal infections such as influenza, malaria, tuberculosis, and hepatitis (9.6%). Most of the maternal mortality happened during the postpartum period and majority of the deaths occurred at the age group of 20-29 years. Overall trend showed that there was a decline from 708 per 100,000 live births in 1990 to 497 per 100,000 in 2013. The annual rate of change over these years was -1.6 (95% UI: -2.8 to -0.3).

Conclusion: The findings of the study highlight the need for comprehensive efforts using multisectoral collaborations from stakeholders for reducing maternal mortality in Ethiopia. It is worthwhile for policies to focus on postpartum period.
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http://dx.doi.org/10.1186/s12889-017-4071-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290608PMC
February 2017

Reaching the unreached through trained and skilled birth attendants in Ethiopia: a cluster randomized controlled trial study protocol.

BMC Health Serv Res 2017 01 26;17(1):85. Epub 2017 Jan 26.

St. Paul Millennium Medical College, Addis Ababa, Ethiopia.

Background: Despite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia. One of the key drivers of maternal mortality in Ethiopia is the very low coverage of Skilled Birth attendance (SBA) in rural Ethiopia. This cluster randomized trial piloted an innovative approach of deploying trained community reproductive nurses (CORN) to hard to reach/unreachable rural Ethiopia to improve the coverage of SBA.

Methods: We used a three-arm cluster randomized trial to test the effect of deploying CORN in rural communities in South Ethiopia to improve SBA and other maternal health indicators. A total of 282 villages/clusters (94 from each arm) were randomly selected in the three districts of the zone for the study. The intervention was implemented in four consecutive phases that aimed at of provision of essential maternal, neonatal and child health (MNCH) services mainly focusing on SBA. The CORN were trained and deployed in health centres (arm 1) and in the community/health posts (arm2). A third arm (arm 3) consisting control villages without the intervention. A baseline and end line assessment was conducted to compare the difference in the proportion of SBA and other MNCH service uptake across the three arms Data was entered into computer, edited, cleaned, and analyzed using Epi-data statistical software. The presentation followed the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines for cluster-randomized trials.

Discussion: This trial is designed to test the impact of an innovative and newly designed means of distribution for the national health extension program strategy with additional service package with no change to the target population. The focus is on effect of CORN in revitalizing the Health Extension Program (HEP) through improving SBA service uptake and other maternal health service uptake indicators. The study findings may guide national policy to strengthen and shape the already existing HEP that has certain limitations to improve maternal health indicators. The competency based training methodology could provide feedback for health science colleges to improve the national nursing or midwifery training curriculum.

Trial Registration: clinicaltrails.gov NCT02501252 dated on July 14, 2015.
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http://dx.doi.org/10.1186/s12913-017-2041-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267394PMC
January 2017

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.

Int J Behav Nutr Phys Act 2016 Dec 16;13(1):122. Epub 2016 Dec 16.

Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.

Background: The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013.

Method: We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors.

Results: In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable.

Conclusions: Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed.
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http://dx.doi.org/10.1186/s12966-016-0447-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159959PMC
December 2016

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.

Popul Health Metr 2016 14;14:42. Epub 2016 Nov 14.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.

Background: Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013.

Methods: We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.

Results: Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths ( = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.

Conclusions: LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.
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http://dx.doi.org/10.1186/s12963-016-0112-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109762PMC
September 2017

Under-five mortality rate variation between the Health and Demographic Surveillance System (HDSS) and Demographic and Health Survey (DHS) approaches.

BMC Public Health 2016 10 24;16(1):1118. Epub 2016 Oct 24.

KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.

Background: Several low and middle-income countries (LMIC) use Demographic and Health Surveys (DHS) and/or Health and Demographic Surveillance System (HDSS) to monitor the health of their population. The level and trends of under-five mortality rates could be different in the HDSS sites compared to the DHS reports. In this study, we investigated the change in under-five mortality rates overtime in the HDSS sites and the corresponding DHS reports in eight countries and 13 sites.

Methods: Under-five mortality rates in the HDSS sites were determined using number of under-five deaths (numerator) and live births (denominator). The trends and annualized rate of change (ARC) of under-five mortality rates in the HDSS sites and the DHS reports were compared by fitting exponential function.

Results: Under-five mortality rates declined substantially in most of the sites during the last 10-15 years. Ten out of 13 (77 %) HDSS sites have consistently lower under-five mortality rates than the DHS under-five mortality rates. In the Kilifi HDSS in Kenya, under-five mortality rate declined by 65.6 % between 2003 and 2014 with ARC of 12.2 % (95 % CI: 9.4-15.0). In the same period, the DHS under-five mortality rate in the Coastal region of Kenya declined by 50.8 % with ARC of 6 % (95 % CI: 2.0-9.0). The under-five mortality rate reduction in the Mlomp (78.1 %) and Niakhar (80.8 %) HDSS sites in Senegal during 1993-2012 was significantly higher than the mortality decline observed in the DHS report during the same period. On the other hand, the Kisumu HDSS in Kenya had lower under-five mortality reduction (15.8 %) compared to the mortality reduction observed in the DHS report (27.7 %) during 2003-2008. Under-five mortality rate rose by 27 % in the Agincourt HDSS in South Africa between 1998 to 2003 that was contrary to the 18 % under-five mortality reduction in the DHS report during the same period.

Conclusions: The inconsistency between HDSS and DHS approaches could have global implication on the estimation of child mortality and ethical issues on mortality inequalities. Further studies should be conducted to investigate the reasons of child mortality variation between the HDSS and the DHS approaches.
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http://dx.doi.org/10.1186/s12889-016-3786-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078973PMC
October 2016

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Authors:
Ali H Mokdad Mohammad Hossein Forouzanfar Farah Daoud Charbel El Bcheraoui Maziar Moradi-Lakeh Ibrahim Khalil Ashkan Afshin Marwa Tuffaha Raghid Charara Ryan M Barber Joseph Wagner Kelly Cercy Hannah Kravitz Matthew M Coates Margaret Robinson Kara Estep Caitlyn Steiner Sara Jaber Ali A Mokdad Kevin F O'Rourke Adrienne Chew Pauline Kim Mohamed Magdy Abd El Razek Safa Abdalla Foad Abd-Allah Jerry P Abraham Laith J Abu-Raddad Niveen M E Abu-Rmeileh Abdulwahab A Al-Nehmi Ali S Akanda Hanan Al Ahmadi Mazin J Al Khabouri Faris H Al Lami Zulfa A Al Rayess Deena Alasfoor Fadia S AlBuhairan Saleh F Aldhahri Suliman Alghnam Samia Alhabib Nawal Al-Hamad Raghib Ali Syed Danish Ali Mohammad Alkhateeb Mohammad A AlMazroa Mahmoud A Alomari Rajaa Al-Raddadi Ubai Alsharif Nihaya Al-Sheyab Shirina Alsowaidi Mohamed Al-Thani Khalid A Altirkawi Azmeraw T Amare Heresh Amini Walid Ammar Palwasha Anwari Hamid Asayesh Rana Asghar Ali M Assabri Reza Assadi Umar Bacha Alaa Badawi Talal Bakfalouni Mohammed O Basulaiman Shahrzad Bazargan-Hejazi Neeraj Bedi Amit R Bhakta Zulfiqar A Bhutta Aref A Bin Abdulhak Soufiane Boufous Rupert R A Bourne Hadi Danawi Jai Das Amare Deribew Eric L Ding Adnan M Durrani Yousef Elshrek Mohamed E Ibrahim Babak Eshrati Alireza Esteghamati Imad A D Faghmous Farshad Farzadfar Andrea B Feigl Seyed-Mohammad Fereshtehnejad Irina Filip Florian Fischer Fortuné G Gankpé Ibrahim Ginawi Melkamu Dedefo Gishu Rahul Gupta Rami M Habash Nima Hafezi-Nejad Randah R Hamadeh Hayet Hamdouni Samer Hamidi Hilda L Harb Mohammad Sadegh Hassanvand Mohammad T Hedayati Pouria Heydarpour Mohamed Hsairi Abdullatif Husseini Nader Jahanmehr Vivekanand Jha Jost B Jonas Nadim E Karam Amir Kasaeian Nega Assefa Kassa Anil Kaul Yousef Khader Shams Eldin A Khalifa Ejaz A Khan Gulfaraz Khan Tawfik Khoja Ardeshir Khosravi Yohannes Kinfu Barthelemy Kuate Defo Arjun Lakshmana Balaji Raimundas Lunevicius Carla Makhlouf Obermeyer Reza Malekzadeh Morteza Mansourian Wagner Marcenes Habibolah Masoudi Farid Alem Mehari Abla Mehio-Sibai Ziad A Memish George A Mensah Karzan A Mohammad Ziad Nahas Jamal T Nasher Haseeb Nawaz Chakib Nejjari Muhammad Imran Nisar Saad B Omer Mahboubeh Parsaeian Emmanuel K Peprah Aslam Pervaiz Farshad Pourmalek Dima M Qato Mostafa Qorbani Amir Radfar Anwar Rafay Kazem Rahimi Vafa Rahimi-Movaghar Sajjad Ur Rahman Rajesh K Rai Saleem M Rana Sowmya R Rao Amany H Refaat Serge Resnikoff Gholamreza Roshandel Georges Saade Mohammad Y Saeedi Mohammad Ali Sahraian Shadi Saleh Lidia Sanchez-Riera Maheswar Satpathy Sadaf G Sepanlou Tesfaye Setegn Amira Shaheen Saeid Shahraz Sara Sheikhbahaei Kawkab Shishani Karen Sliwa Mohammad Tavakkoli Abdullah S Terkawi Olalekan A Uthman Ronny Westerman Mustafa Z Younis Maysaa El Sayed Zaki Faiez Zannad Gregory A Roth Haidong Wang Mohsen Naghavi Theo Vos Abdullah A Al Rabeeah Alan D Lopez Christopher J L Murray

Lancet Glob Health 2016 10 25;4(10):e704-13. Epub 2016 Aug 25.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S2214-109X(16)30168-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660972PMC
October 2016

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

Ethiop J Health Sci 2015 Oct;25(4):345-52

Department of Epidemiology and Biostatistics, Jimma University, Ethiopia.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762973PMC
http://dx.doi.org/10.4314/ejhs.v25i4.8DOI Listing
October 2015

The Effect of Early Initiation of Antiretroviral Therapy in TB/HIV-Coinfected Patients: A Systematic Review and Meta-Analysis.

J Int Assoc Provid AIDS Care 2015 Nov-Dec;14(6):560-70. Epub 2015 Aug 19.

KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

Background: The importance of early initiation of antiretroviral therapy (ART) for tuberculosis (TB) and HIV-coinfected patients is controversial. We conducted a systematic review and meta-analysis to assess the effect of early initiation of ART (within 2-4 weeks of TB treatment) on several treatment outcomes among TB/HIV-coinfected patients.

Method: A systematic search of clinical trials was performed in PubMed, Embase, Google Scholar, Science Direct, Medscape, and the Cochrane library. Clinical trials which were published in any language before the last date of search (March 31, 2015) were included. The qualities of the studies were assessed using criteria from the Cochrane Library. Heterogeneity test was conducted to assess the variations among study outcomes. For each study outcome, the risk ratio (RR) with 95% confidence interval (CI) was calculated as a measure of intervention effect. The Mantel-Haenszel method was used to estimate the RR using a fixed-effects model.

Findings: A total of 2272 study participants from 6 trials were included in the meta-analysis. Early ART initiation during TB treatment was associated with reduced all-cause mortality (RR = 0.78; 95% CI = 0.63-0.98) and increased rate of TB-associated immune reconstitution inflammatory syndrome (TB-IRIS; RR = 2.19; 95% CI = 1.77- 2.70) and death related to TB-IRIS (RR = 6.94; 95% CI = 1.26-38.22). However, the time of ART initiation has no association with TB cure rate (RR = 0.99; 95% CI = 0.81-1.07), rate of drug toxicity (RR = 1.00; 95% CI = 0.93-1.08), death associated with drug toxicity (RR = 0.40; 95% CI = 0.14- 1.16), rate of low viral load (less than 400 copies/mL; RR = 1.00; 95% CI = 0.96-1.04), and rate of new AIDS-defining illness (RR = 0.84; 95% CI = 0.60-1.18). Immunological response in early ART arms of study participant in different trials showed a greater or equal response compared with late ART arms.

Conclusion: This systematic review presents conclusive evidence on the reduction of all-cause mortality as a result of early initiation of ART. However, this study also confirms the high rate of TB-IRIS and death associated with it. Operational and implementation research are required to maintain the benefit of early ART initiation and proper management of TB-IRIS. Studies on the timing of ART in extrapulmonary and multidrug-resistant TB are recommended.
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http://dx.doi.org/10.1177/2325957415599210DOI Listing
March 2016

Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study.

Pan Afr Med J 2014 17;17:26. Epub 2014 Jan 17.

Department of Epidemiology, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia.

Introduction: Isoniazid preventive therapy (IPT) reduces the risk of active TB. IPT is a key public health intervention for the prevention of TB among people living with HIV and has been recommended as part of a comprehensive HIV and AIDS care strategy. However, its implementation has been very slow and has been impeded by several barriers.

Objective: The Objective of the study is to assess the perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings in Addis Ababa, Ethiopia in 2010.

Methods: A qualitative study using a semi-structured interviewed guide was used for the in-depth interview. A total of 12 key informants including ART Nurse, counselors and coordinators found in four hospitals were included in the interview. Each session of the in-depth interview was recorded via audio tape and detailed notes. The interview was transcribed verbatim. The data was analyzed manually.

Results: The findings revealed that poor patient adherence was a major factor; with the following issues cited as the reasons for poor adherence; forgetfulness; lack of understanding of condition and patient non- disclosure of HIV sero-status leading to insubstantial social support; underlying mental health issues resulting in missed or irregular patient appointments; weak patient/healthcare provider relationship due to limited quality interaction; lack of patient information, patient empowerment and proper counseling on IPT; and the deficient reinforcement by health officials and other stakeholders on the significance of IPT medication adherence as a critical for positive health outcomes.

Conclusion: Uptake of the implementation of IPT is facing a challenge in resource limited settings. This recalled provision of training/capacity building and awareness creation mechanism for the health workers, facilitating disclosure and social support for the patients is recommended.
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http://dx.doi.org/10.11604/pamj.2014.17.26.2641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048699PMC
April 2015

Prevalence and distribution of schistosomiasis in afder and gode zone of somali region, ethiopia.

J Glob Infect Dis 2013 Oct;5(4):149-52

Department of Clinical Medicine, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom ; Department of Epidemiology, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

Background: There is no recent information about the prevalence and distribution of schistosomiasis in the Somali national regional state of Ethiopia. Ethiopia launched the national integrated neglected tropical diseases (NTDs) Master Plan in June 2013. The Master Plan identified mapping NTDs as a prerequisite for launching control programs. Therefore it is important to understand the prevalence and distribution of schistosomiasis in respective regions.

Materials And Methods: From February to March 2011, a cross-sectional survey was done in school-aged children from six districts of Afder Gode zone. Urine samples were collected and examined for ova of Schistosoma haematobium using the sedimentation technique and stool samples were collected and examined for S. mansoni using the Kato-Katz technique. A semistructured questionnaire was used to collect sociodemographic characteristics of the participants.

Results: Of the 523 children, 513 (98%) of them participated in the study. The prevalence of S. haematobium was 16.0% (95% confidence interval (CI); 12.8-19.2). The rate of the disease was not uniform across the various six communities studied (x(2) = 208.8, P < 0.0001). Musthail district had the highest prevalence with 64.2% (95% CI; 60.0-68.3) followed by Kelafo with 11.8% (95% CI; 9.0-14.6). No infections of S. mansoni were found in these settings. There was no difference in the prevalence of infection across age groups. Boys were more likely to be infected by S. haematobium than girls (odds ratio = 1.68; 95% CI: 1.1-2.7).

Conclusion: S. haematobium infection is prevalent in the region with varying distribution across the districts. According to the World Health Organization, mass drug administration should be considered in some of the districts.
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http://dx.doi.org/10.4103/0974-777X.122007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958984PMC
October 2013

Evaluation of the 2007 WHO guideline to diagnose smear negative tuberculosis in an urban hospital in Ethiopia.

BMC Infect Dis 2013 Sep 11;13:427. Epub 2013 Sep 11.

Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.

Background: The 2007 World Health Organization (WHO) guideline to diagnose smear-negative tuberculosis (TB) in HIV-prevalent settings was mainly based on expert advice and therefore requires evaluation in real life situations.

Methods: In 2009, this guideline was introduced at the ALERT hospital in Ethiopia. From October 2009 to January 2011, the accuracy of the guideline was evaluated using Mycobacterium tuberculosis culture positivity as reference standard in HIV positive TB suspects.

Results: A total of 459 TB suspects were enrolled during the study period; 336 (73.2%) were HIV positive. Acid fast bacilli sputum smear microscopy was done for 74.7% (251/336) HIV positive TB suspects; 94.4% (237/251) were smear negative. A chest X-ray was performed in 92.8% (220/237) and a Mycobacterium tuberculosis culture in 63.7% (151/237). The median TB diagnostic delay for smear negative cases was 3 days (interquartile range 3-4 days). Of the 75 patients diagnosed with smear negative pulmonary TB, 89. 4% (67/75) were diagnosed by chest X-ray, 9.4% (7/75) by culture and 1.3% (1/75) by clinical suspicion only. In 147 smear negative TB suspects Mycobacterium tuberculosis culture and chest X-ray results were available. Among these 147 patients, the sensitivity of the chest X-ray to diagnose smear negative TB in HIV-positive TB suspects was 53.3% (95% CI: 26.7-78.7); the specificity 67.4% (95% CI: 58.7-75.3).

Conclusion: The 2007 WHO diagnostic algorithm for the diagnosis of smear negative TB is likely to reduce the diagnostic delay and therefore decrease morbidity and mortality of TB in a HIV prevalent settings like Ethiopia.
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http://dx.doi.org/10.1186/1471-2334-13-427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849989PMC
September 2013

Predictors of Mortality among Tuberculosis/HIV-Coinfected Persons in Southwest Ethiopia: A Case-Control Study.

J Int Assoc Provid AIDS Care 2015 May-Jun;14(3):269-73. Epub 2013 Aug 21.

Department of Health Studies, UNISA, Pretoria, South Africa.

Background: Tuberculosis (TB) remains the most common cause of death in people living with HIV/AIDS. The aim of the present study was to identify predictors of mortality in TB/HIV-coinfected patients.

Methods: We conducted an unmatched case-control study among a cohort of TB/HIV-coinfected adults who were on antiretroviral therapy (ART). Cases comprised 69 TB/HIV-coinfected patients who died during this period. For each case, we selected 3 (207) TB/HIV-coinfected patients who were alive during the end of the follow-up period.

Results: Male sex (odds ratio [OR] = 2.04, 95% confidence interval [CI]: 1.04-4.02), being bedridden at enrollment (OR = 2.84, 95% CI: 1.17-6.89), and cough of more than 2 weeks during initiation of ART (OR = 4.75 95% CI: 2.14-10.56) were the best predictors of mortality among TB/HIV-coinfected patients.

Conclusion: Mortality among TB/HIV-coinfected patients accounted for a considerable number of deaths among the cohort. Patients with cough at ART initiation and with poor functional status should be strictly followed to reduce death.
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http://dx.doi.org/10.1177/2325957413500528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928041PMC
September 2015

Do common mental disorders decline over time in TB/HIV co-infected and HIV patients without TB who are on antiretroviral treatment?

BMC Psychiatry 2013 Jun 27;13:174. Epub 2013 Jun 27.

Department of Epidemiology, Jimma University, Jimma, Ethiopia.

Background: The relationship between TB/HIV co-infection and common mental disorders (CMD) is not well investigated. A follow up study was conducted to assess the change in CMD over a 6-months period and its predictors among TB/HIV co-infected and HIV patients without TB in Ethiopia.

Methods: A longitudinal study was conducted in 2009. A total of 465 HIV/AIDS patients without TB and 124 TB/HIV co-infected patients from four antiretroviral treatment (ART) centers in Ethiopia were recruited to assess CMD and quality of life (QoL). CMD and QoL were assessed at baseline and at six month using the Kessler-10 scale and the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Bref) respectively. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in CMD and its predictors.

Results: At the 6 month, 540 (97 TB/HIV co-infected and 455 HIV/AIDS patients without TB) patients completed the follow up and 8.6% (21% among TB/HIV co-infected and 2.2% among HIV patients without TB) lost to follow-up.At baseline, 54.4% of TB/HIV co-infected patients had mild to severe mental disorder compared to 41.2% among HIV patients without TB. At the six month follow up, 18.1% of TB/HIV co-infected patients had mild to severe mental disorder compared to 21.8% among HIV patients without TB. The decline of the prevalence of any form of metal disorder was 36.3% among TB/HIV co-infected patients compared to 19.4% among HIV patients without TB (P<0.001).QoL was strongly associated with CMD in TB/HIV co-infected patients and HIV patients without TB (β = -0.04, P<0.001) after controlling the effect of several confounding variables such as sex, income, WHO disease stage, duration on ART, CD4 lymphocyte count, adherence to ART and social support.

Conclusion: The prevalence of CMD has significantly reduced particularly among TB/HIV co-infected patients over a 6 months period. Poor QoL is the major independent predictors of CMD. We recommend integration of mental health services in TB/HIV programs. Training of health care providers at TB/HIV clinics could help to screen and treat CMD among TB/HIV co-infected patients.
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http://dx.doi.org/10.1186/1471-244X-13-174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702441PMC
June 2013

Change in quality of life: a follow up study among patients with HIV infection with and without TB in Ethiopia.

BMC Public Health 2013 Apr 29;13:408. Epub 2013 Apr 29.

Department of Epidemiology, Jimma University, Jimma, Ethiopia.

Background: There is a dearth of literature on the impact of TB/HIV co-infection on quality of life (QoL). We conducted a study to assess the change in QoL over a 6-months period and its predictors among HIV-infected patients with and without TB in Ethiopia.

Methods: 465 HIV-infected patients without TB and 124 TB/HIV co-infected patients were enrolled in a prospective study in February, 2009. 455 (98%) HIV-infected and 97 (78%) TB/HIV co-infected patients were followed for 6 months. Data on QoL at baseline and 6th month were collected by trained nurses through face to face interviews using the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Brief). Common Mental Disorder (CMD) was assessed using a validated version of the Kessler-10 scale. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in QoL and its predictors.

Results: There was a statistically significant improvement of the physical, psychological, social, environmental and spiritual QoL at the 6th months follow up compared to the baseline for both groups of patients (P < 0.0001). The change in QoL in all dimension were more marked for TB/HIV co-infected patients compared to HIV-infected patients without TB.A severe form of CMD was strongly associated with poorer physical QoL among TB/HIV co-infected individuals (β = -2.84; P = 0.000) and HIV clients without TB (β = -2.34; P = 0.000).

Conclusion: This study reveals that ART and anti-TB treatment significantly improve the QoL particularly among TB/HIV co-infected patients. We recommend that the ministry of health in collaboration with partners shall integrate mental health services into the TB/HIV programs and train health care providers to timely identify and treat CMD to improve QoL.
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http://dx.doi.org/10.1186/1471-2458-13-408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649920PMC
April 2013

Predictors of change in CD4 lymphocyte count and weight among HIV infected patients on anti-retroviral treatment in Ethiopia: a retrospective longitudinal study.

PLoS One 2013 3;8(4):e58595. Epub 2013 Apr 3.

Population Studies and Training Center, Brown University, Providence, Rhode Island, United States of America.

Background: Antiretroviral treatment (ART) has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment.

Objective: To determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia.

Methods: A retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort.

Results: Both the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48-8.34; p 0.000) and weight (beta 0.15; 95% CI 0.13-0.18; p 0.000). Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05).

Conclusion: We detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058595PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616015PMC
October 2013

Glaucoma subtypes in Ethiopian clinic patients.

J Glaucoma 2013 Feb;22(2):110-6

Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.

Background: Until population-based data become available in Ethiopia, hospital-based studies may reflect the distribution of the subtypes of glaucoma in certain parts of the country.

Purpose: The main aim of this study was to determine the subtypes of glaucoma in Jimma University Hospital, Ethiopia.

Methods: A facility-based cross-sectional study was conducted in Jimma University Hospital from April 1, 2007 to March 30, 2008. The study population consisted of 335 consecutive new and follow-up patients with glaucoma diagnosed based on strict objective criteria.

Results: The mean (SD) age of the study patients was 57.0 (12.7) years (range, 8 to 90 y). The male to female ratio was 2.7:1. The 2 most common subtypes of glaucoma found were exfoliation glaucoma (35.2%) and primary open angle glaucoma (32.8%). Primary angle closure glaucoma was diagnosed in 18.5% of patients.

Conclusions: The finding of exfoliation glaucoma as the most common subtype of glaucoma in the present clinic-based study is interesting. Such observation has never been reported from anywhere in Africa. We recommend community-based surveys to define the real distribution of the glaucoma subtypes in Ethiopia.
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http://dx.doi.org/10.1097/IJG.0b013e31823298c8DOI Listing
February 2013