Factors associated with maternal mortality in Addis Ababa, Ethiopia

A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.     

Perception and management of tuberculosis symptoms in Addis Ababa, Ethiopia

Management of early tuberculosis (TB) symptoms and adherence to medical treatment are main challenges in controlling TB. The aim of this study is to explore how symptoms of TB are perceived and managed, from the onset of symptoms and during the course of treatment, in Addis Ababa, Ethiopia. We conducted a qualitative interview study, including 50 in-depth interviews and 2 focus groups, with TB patients, their relatives, and health personnel. We found that a patient's perceptions and self-treatment of early symptoms could cause diagnostic delay. Stigma associated with TB and public health services made many patients approach private clinics, causing further delay. Both private and public clinics often labeled and managed symptoms according to lay explanatory models. Lack of adequate knowledge about TB's etiology and cure caused patients to continue relating to symptoms by reference to their own understanding. This affected patients' ability to manage TB and its treatment.     

Utilization of pharmacies and pharmaceutical drugs in Addis Ababa, Ethiopia

This paper examines recent developments in the pharmaceutical retail trade in socialist Ethiopia and presents the results of two surveys on pharmacy utilization in Addis Ababa. Surveys were carried out in 6 private and 5 government pharmacies. Objectives are: (1) to examine drug retailer utilization in relation to locational, transportation and retailer-related factors; (2) evaluate the role of socioeconomic factors in pharmacy and drug utilization; and (3) determine distance decay associated with clients' trip origins and the location of their residences as indicators of service areas. Although most clients originated in Addis Ababa, large numbers came from rural areas, especially in the pharmacies near large markets and other shopping areas in the inner city. Centrally located retailers also served more Addis Ababa residents and larger sections of the city than peripherally located retailers, largely due to a combination of urban structure, distribution of health care facilities, prevailing drug shopping behavior and population distribution. Government pharmacies had larger service areas and served larger numbers of clients than private pharmacies, primarily due to lower prices and greater availability of pharmaceuticals. Mean distance from pharmacies to places of origin of trips was smaller than mean distance from pharmacies to residences of the same clients. Similarly, distance decay gradients were steeper for the former than the latter in the 4 pharmacies studied in the second part of the survey, indicating the greater suitability of origin of trip as a parameter of service area. Type and price of drugs purchased were associated with socioeconomic factors, particularly level of education and housing/environmental health conditions in two districts, but there was little variation in the small number of drugs purchased per client. Several forms of drug-purchasing behavior of pharmacy clients and selling practices of private retailers are described as adaptive responses to prevailing economic and sociopolitical conditions. The study concludes that population-based studies of disease occurrence and health behavior are needed to better evaluate the health needs of the population for the planning of additional drug retailers in Addis Ababa's suburban districts.     

Prevalence of hepatitis B infection among hospital personnel in Addis Ababa (Ethiopia)

Hepatitis B serological markers (HBsAG, anti-HBc and anti-HBs) were determined in 432 (60%) hospital employees by the Hepanostika microenzyme linked immunoassay method.The overall prevalence rate was 9.02% for HBsAg, 46.25% for anti-HBs, 73.6% for anti-HBc and 76.38% for at least one marker positive. Marker positivity as well as HBsAg carrier rate is higher for males than for females. (82.0 Vs 69.9%; 11.4 Vs 6.75% respectively). The majority of the infections occur early in life, 75% being positive for at least one marker by age twenty. The distribution of markers is somewath different from previous observations with non-hospital personnel.Departments most exposed to blood and certain job categories seem to be an increased risk of acquiring the infection.We conclude that hospital exposure is associated with an additional risk of hepatitis B infection.     

Preterm Neonatal Mortality and its predictors in Tikur Anbessa Specialized Hospital,Addis Ababa,Ethiopia: a retrospective cohort study

BackgroundPreterm neonatal death is a global problem. In Ethiopia, it is still high, and the trend in reduction is slower as compared to child mortality. Preterm neonatal birth is the leading cause. The magnitude and associated factors are also not well documented. Therefore, this study aimed to estimate the incidence of mortality and its predictors among preterm neonates in Tikur Anbesa Specialized Hospital (TASH).MethodsAn institution-based retrospective cohort study was conducted among 604 preterm neonates admitted to Tikur Anbesa Specialized Hospital. Data were collected by reviewing patient charts using systematic sampling with a checklist. The data entry was done using EpiData version 4.2, and analysis was done using Stata Version 14.1. Kaplan-Meier and log-rank tests were used to estimate the survival time and to compare it. Cox proportional hazard was also fitted to identify major predictors. Hazard Ratios (HRs) with 95% Confidence Intervals (CI) were used to assess the relationship between factors associated with the occurrence of death. Finally, statistical significance was declared at p-value < 0.05.ResultsIn this study, a total of 604 patient charts were reviewed; of these, 571 met the inclusion criteria and were recruited to the study. A total of 170(29.7%) preterm neonates died during the follow-up period. The median follow-up time of preterm neonate under the cohort was 21 days (IQR: 4, 27). The incidence rate was 39.1 per 1000-person day. Rural residency (AHR: 1.45 (95% CI: 1.1,4.8)), Maternal diabetic Mellitus (AHR:2.29 (95%CI: 1.43,3.65), neonatal sepsis (AHR:1.62 (95% CI: 1.11,2.37), respiratory distress (AHR:1.54 (95% CI:1.03, 2.31), extreme prematurity (AHR:2.87 (95% CI:1.61, 5.11), and low APGAR score (AHR:3.11 (95% CI:1.79, 5.05) was found to be predictors.ConclusionThe rate of preterm neonatal mortality is still an important problem. Having maternal gestational Diabetic Mellitus, neonatal sepsis, respiratory distress, and low Apgar score were major predictors for preterm neonatal mortality. Therefore, efforts have to be made to reduce the incidence of death and for timely management of mothers with Diabetic Mellitus. Healthcare professionals should also work on early diagnosis and treatment of preterm neonate with sepsis, respiratory distress, and low Apgar score.     

Perceived stigma and discrimination towards people living with HIV and AIDS in Addis Ababa, Ethiopia: a qualitative approach

Aim

HIV prevalence in Ethiopia is over 7 % in urban areas. Stigma toward people living with HIV and AIDS hampers prevention, seeking care, and treatment.

Subject and methods

In Addis Ababa, in 2009, we conducted 12 focus groups (n?=?43), 5 with HIV positive subjects and 7 with subjects of unknown status. Through open-ended questions with directing probes, we evaluated community perception, attitudes, and causes and patterns of stigma towards people living with HIV. We transcribed, coded, analyzed and developed major contextualized themes.

Results

Stigma is pervasive, with a wide range of misconceptions about HIV. Contributing factors are: lack of awareness and education, fear, lack of experience with HIV positive community, and limited knowledge about effective treatment. Most participants believed that the slight positive trend in stigma and discrimination is due to better awareness through media and educational programs, and the increased visibility of the HIV epidemic.

Conclusion

There is a need to improve individual and community knowledge and to reduce misconception using family- and community-oriented educational programs. A multi-disciplinary approach tailored towards Ethiopian society, emphasizing primarily local community initiatives, and applying nation-wide structural and environmental strategies coupled with international efforts, is warranted.     

Sero-epidemiology of rubella in the urban population of Addis Ababa, Ethiopia

We conducted a community-based cluster sample survey of rubella sero-epidemiology in Addis Ababa, Ethiopia in 1994. Among 4666 individuals for whom complete data were available, rubella antibody prevalence was 91% (95% confidence interval: 90, 92). On multivariable analysis, seroprevalence was lower among individuals who were resident in Addis Ababa for 1 year or less. Approx. 50% seroprevalence was attained by age 4 years, and the estimated average age at infection was 5.2 years. The highest age-specific force of infection was estimated to occur in 5- to 9-year-olds. The early age at infection corresponded with a low estimated incidence of congenital rubella syndrome (CRS) of 0.3 per 1000 live births, equivalent to nine cases of CRS in 1994. The predicted critical level of immunity for elimination of rubella via vaccination was 85-91%, requiring 89-96% coverage with a vaccine of 95% effectiveness. Unless very high coverage of rubella vaccine could be guaranteed, the introduction of childhood vaccination could increase the incidence of CRS in Addis Ababa.     

Differential use of adolescent reproductive health programs in Addis Ababa,Ethiopia

PurposeAdolescent reproductive health programs in Africa have largely remained as small-scale pilot programs, however, there is increasing interest in bringing programs to scale. Evaluations have focused on individual programs and few have gathered population-based information on the reach of program models and the profile of adolescents who utilize services, versus those who do not. This study examines the coverage and utilization of existing adolescent programs in Addis Ababa, Ethiopia.MethodsPopulation-based surveys were undertaken among over 1000 adolescents aged 10 to 19 years in slum areas of Addis Ababa, Ethiopia. An inventory of youth programs including youth centers and peer education programs was compiled in the study area.ResultsEight peer education programs and six youth centers were operating in the study area. Twenty percent of boys and only 7% of girls had visited a youth center in the last year; 27% of boys and 15% of girls had had contact with a peer educator. Older adolescents, especially boys, were more likely to utilize programs. Girls who work long hours and who are isolated are less likely to access and benefit from programs.ConclusionsGreater segmentation of the adolescent population is needed in the design and content of adolescent reproductive health programs. In addition, programmers should pay attention to the specific circumstances of young people in local settings, particularly vulnerable, hard-to-reach sub-groups of adolescents, including girls.     

Precursors of atherosclerotic and hypertensive diseases among adolescents in Addis Ababa, Ethiopia.

The present study measured the prevalence of the precursors of atherosclerosis among 519 adolescents selected from high-school students in Addis Ababa. Also assessed was their knowledge about these precursors and about the hazards of smoking and of heavy alcohol consumption. A total of 13.8% of the adolescents smoked, 11.6% had a sedentary lifestyle, 9.2% consumed alcohol heavily, 14.1% were obese, 30.3% had one risk factor, and 4.4% had two risk factors for atherosclerosis. Altogether, 58% had inadequate knowledge about the precursors of atherosclerosis, and 62% and 51.4%, respectively, had inadequate knowledge about the hazards of smoking and of consuming alcohol. High-risk behaviours were positively associated with upper-income families and inadequate knowledge about the precursors of atherosclerosis. A substantial proportion of adolescents in Addis Ababa therefore exhibit the precursors of atherosclerotic and hypertensive diseases. Further, similar studies should be carried out in other Ethiopian cities, and the Ministries of Health and Education should give due attention to the primary prevention of these diseases and formulate plans for appropriate actions.     

Oral and anal sex practices among high school youth in Addis Ababa,Ethiopia

Background  

Understanding the full range of sexual behaviors of young people is crucial in developing appropriate interventions to prevent and control sexually transmitted infections including HIV. However, such information is meager in developing countries. The objective of this study was to describe oral and anal sex practices and identify associated factors among high school youth.     

Seroepidemiology of measles in Addis Ababa,Ethiopia: implications for control through vaccination

We undertook a representative survey of measles antibodies in Addis Ababa, Ethiopia 1994, to characterize immunity and transmission. Specific-antibody levels (IU/l) were determined by ELISA for 4654 sera from individuals aged 0-49 years (1805 < 15 years) collected by stratified household-cluster sampling. The proportion seronegative (< 100 IU/l) was 20% (95% CI: 16-25) in children 9-59 months old, declining to 9% (7-12) in 5-9 year olds, 5% (4-7) in 10-14 year olds, and < 1% in adults. The proportion of children (< 15 years old) with low-level antibody (100-255 IU/l) was 8% (7-10). Vaccination and an absence of a history of measles illness were strongly associated with low-level antibody. History of measles vaccination in 9 months to 14-year-old children was approximately 80%. We estimate a primary vaccine failure rate of 21% (12-34) and continued high measles incidence of 22 per 100 susceptibles (19-24) per annum. Our data support the introduction of campaign vaccination in the city in 1998, although higher routine vaccine coverage is required to sustain the impact. The implications of a high prevalence of low-level antibody are discussed.     

Mass Hysteria among Beneficiary Students of the School-Feeding Program in Addis Ababa,Ethiopia

BackgroundMass hysteria is described as the rapid spread of conversion disorder without organic basis among a group of people. Mass hysteria can occur in work place and commonly in schools. There are usually some factors attributable to the episode; however, the lack of a pathogen upon investigation is a fundamental characteristic. We are reporting an episode of mass hysteria from two schools in Addis Ababa, Ethiopia.MethodsClinical record, laboratory investigation, toxicology study from the food and psychiatric evaluations.ResultsOn November 25, 2019 a total of 113 students were brought from two schools in Addis to Tikur Anbessa Specialized Hospital. Most were between the ages of 10 and 15 years and were female students. Their school breakfast of bread and marmalade was attributed as the cause of the episode; however only 49% of the students brought in had eaten the food. The majority complained of nausea and vomiting but most had normal physical finding; and their symptoms were resolved without treatment. The laboratory investigation on samples of blood and stool were negative for bacterial growth and food culture and toxicology were non-revealing. Most were reassured and few were given symptomatic treatment.ConclusionThis mass hysteric episode is similar to episodic reports from other school feeding programs in some Asian and African countries. The finding of this report is important for health care practitioners to consider mass psychogenic illness in case they face similar mass presentation without objective finding; and will help to avoid unnecessary costly investigations.     

The proximate determinants of the decline to below-replacement fertility in Addis Ababa,Ethiopia

Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility.     

新疆维吾尔自治区艾滋病抗病毒治疗者不同性别死亡率及其影响因素分析

目的 了解不同性别抗病毒治疗者死亡率及其影响因素,为提高抗病毒治疗效果提供思路和方法。方法 以新疆维吾尔自治区(新疆)2004年7月至2013年6月进行高效抗反转录病毒治疗的男性8 061例,女性6 001例为研究对象。数据来源于国家“艾滋病综合防治信息系统”中“抗病毒治疗信息系统”。采用回顾性研究方法,分析不同性别抗病毒治疗者死亡率和累积生存率,采用Cox回归模型分析死亡的影响因素。结果 HIV传播途径男性以静脉注射吸毒为主,女性以性途径为主。男性抗病毒治疗者年龄偏大,基线CD₄⁺T淋巴细胞计数水平偏低;整体死亡率高于女性,治疗早期死亡率高达10.87/100人年,两年后降至7.00/100人年以下。女性治疗早期死亡率为4.77/100人年,两年后降至3.00/100人年。Cox回归分析结果显示:死亡率的影响因素为基线CD₄⁺T淋巴细胞计数水平和感染途径。CD₄⁺T淋巴细胞计数(cell/μl)< 200者(对照为≥350),男性的HR=4.08(95%CI:2.96～5.62),女性的HR=5.11(95%CI:3.16～8.35)。静脉注射吸毒者(对照为性途径感染),男性的HR=1.99(95%CI:1.66～2.40),女性的HR=1.77(95%CI:1.24～2.52)。累积生存率分析结果显示:常规治疗组经性途径感染的男性与女性5年生存率分别为81%与87%,经静脉吸毒感染的男性与女性5年生存率分别为66%与75%,性别差异有统计学意义。早治疗组经性途径感染的男性与女性5年生存率分别为97%与98%,经静脉吸毒感染的男性与女性5年生存率分别为86%与97%,无性别差异。结论 新疆男性抗病毒治疗者较高的死亡率,源于该群体较低的基线CD₄⁺T淋巴细胞计数水平及较高的经静脉注射吸毒感染比例。另外,男性主动服药意愿偏弱及服药依从性偏低为深层次影响因素。     

Demographic impact of AIDS in a low-fertility urban African setting: projection for Addis Ababa,Ethiopia

The study estimated the potential demographic impact of acquired immunodeficiency syndrome (AIDS) in a low-fertility urban setting in sub-Saharan Africa. The prevalence of human immunodeficiency virus (HIV) projected using a deterministic mathematical model was put into the AIDS Impact Model (AIM) of the SPECTRUM Policy Modelling System to estimate the potential demographic impact ofAIDS in Addis Ababa, Ethiopia. Demographic indicators from 1984 (the start of the HIV epidemic in Ethiopia) to 2024, including and excluding the HIV epidemic, were compared. Addis Ababa is experiencing a demographic transition in which the total fertility rate has declined from 3.8 to below replacement level over the last 20 years. The prevalence of HIV is predicted to stabilize at 10% in adults, resulting in a total number of people living with HIV at 200,000 and a cumulative number of deaths due to AIDS at 50,000. About 60% of adult deaths can be attributable to AIDS by 2000. The epidemic is predicted to reduce life expectancy by 10 and 17 years in 2000 and 2024 respectively, and to turn to negative, the rate of natural increase after 2009. Accordingly, the rate of natural increase will be -0.18%, -0.35%, and -0.71% per annum by 2009, 2014, and 2024 respectively. Population growth is expected to continue with or without HIV, as a result of high net in-migration, although data for migration are scanty. In a low-fertility urban society of Africa, this study shows the potential for the HIV/AIDS epidemic to turn the rate of natural increase to negative.     

Low haemoglobin predicts early mortality among adults starting antiretroviral therapy in an HIV care programme in South Africa: a cohort study

Background  

Antiretroviral therapy (ART) has dramatically reduced morbidity and mortality among people with HIV infection; however, mortality after the start of ART is high in resource-limited settings. We investigated risk factors for mortality among adults starting ART in a multi-clinic community programme in South Africa.     

Seroepidemiology of hepatitis B virus in Addis Ababa,Ethiopia: transmission patterns and vaccine control

A community-based seroepidemiological survey of Addis Ababa, Ethiopia was conducted in 1994 to inform on the transmission dynamics and control of hepatitis B virus (HBV) infection. Venous blood from 4736 individuals under 50 years of age from 1262 households, selected using stratified cluster-sampling, was screened for HBV markers using commercial ELISAs. HBsAg prevalence was 7% (95 % CI 6-8), higher in males (9%; 7-10) than females (5%; 4-6). HBeAg prevalence in HBsAg positives was 23% (18-29), and less than 1% of women of childbearing age were HBeAg positive. Overall HBV seroprevalence (any marker), rose steadily with age to over 70% in 40-49 year olds, indicating significant childhood and adult transmission. Estimated instantaneous incidence was 3-4/100 susceptibles/year, higher in males than females in 0-4 year olds, and peaking in early childhood and young adults. The age at which 50% had evidence of infection was around 20 years, and the herd immunity threshold is approximated at 63-77%. Addis Ababa is of intermediate-high HBV endemicity, with negligible perinatal transmission. Our main findings are the identification of a significant difference between males and females in the age-acquisition of HBV infection, and marked differences between age groups in HBV incidence rates. These results should target future research studies of underlying risk factors. Furthermore, we generate a crude estimate of the level of coverage of HBV vaccine that would be required to eliminate the virus from the study population.