HIV/AIDS prevention practices among military personnel in Northwest Ethiopia

ABSTRACT

The spread of HIV/AIDS is a major public health problem in military personnel in Africa. However, the epidemiological evidence regarding HIV/AIDS prevention practices among military personnel in Ethiopia remains unclear. The aim of this study was to investigate HIV/AIDS prevention practices among military personnel in Northwest Ethiopia. A cross-sectional study among military personnel (n?=?410) was conducted in Northwest Ethiopia in 2015. Data were collected using a pre-tested questionnaire. Multivariable logistic regression model was fitted to ascertain factors influencing participation in HIV/AIDS prevention programs. About one-fourth (24.6%) of the military personnel had multiple sexual partners, of whom 24.7% failed to use condoms regularly when having sex with non-regular sexual partners. Majority of the sample (n?=?355, 86.6%) participated in HIV/AIDS prevention programs. Military personnel who had multiple sexual partners were 6.3 times more likely to report history of non-participation in HIV/AIDS prevention programs (AOR?=?6.3, CI₉₅?=?3.5–11.54). A considerable proportion of military personnel had multiple sexual partners with lower levels of condom utilization with non-regular sexual partners. The study further demonstrated misconceptions about HIV/AIDS in Ethiopian military personnel, which reduce their likelihood of participation in HIV/AIDS prevention programs. Health authorities need to strengthen and accelerate HIV/AIDS prevention programs focusing towards military personnel.     

Pattern of admissions to the medical intensive care unit of Addis Ababa University Teaching Hospital

A case-series study of all admissions using patient registers was carried out to analyse patterns of medical admissions into the Medical Intensive Care Unit (MICU) of the Addis Ababa University Teaching Hospital, and evaluate for any changes in that pattern over a study period. All patients admitted to the MICU of a 500-bed Teaching Hospital in Addis Ababa between 1985-2000 were the study subjects. Demographic variables, specific categories of diagnoses and their outcomes were recorded A total of 3548 patients (male to female ratio of 1.4:1, mean age 37.10 +/- 17.29) were admitted from September 1985 to August 2000. Acute infectious and cardiovascular diseases accounted for half of the entire critical care admissions with infectious diseases accounting for 30%. Among specific diagnoses, diabetic ketoacidosis was the leading cause of admission followed by acute myocardial infarction and severe and complicated malaria, each accounting for 10.7, 9.8 and 9.3% of all admissions respectively. Trends of admissions over the sixteen-year period showed steady increase in relative frequency of acute complications of non-communicable diseases consisting of diabetes, acute myocardial infarction and stroke while infectious diseases showed interspersed peaks of admissions coinciding with epidemics. The overall mortality of the MICU was 32%, with proportionally more female deaths, 34.8 versus 29% (P = 0.0002). Severe and complicated malaria was the leading cause of death (10.3%) followed by tetanus (6.4%) and acute myocardial infarction (6.3%). The increase in relative and absolute frequency of acute complications of non-communicable diseases most probably heralds an emerging epidemic of non-communicable diseases related to life style changes in the urban well to do in addition to existing problems of infectious diseases of poverty.     

Weight-for-age of children admitted to the Ethio-Swedish Children's Hospital, Addis Ababa, 1978

The weight-for-age of 1235 hospital-admitted children aged between one month and 14 years was assessed. Sixty per cent (764) of child admissions in all age groups had weights less than 80% of the Harvard reference weight-for-age value; 27% (339) had weights less than 60% of the Harvard reference weight-for-age value. Of children who were diagnosed to suffer from protein-energy malnutrition on admission, marasmus was diagnosed most frequently, followed by marasmic-kwashiorkor and kwashiorkor. Seventy-five per cent of child admissions who died in hospital had weights less than 80% of the reference; the lower the child's admission weight-for-age, the higher the likelihood of death. A significantly higher proportion (P less than 0.01) of female admissions weighed less than 60% of reference weight-for-age compared with male admissions. Girls diagnosed as suffering from marasmus had a higher death rate than boys with a similar diagnosis. Children from poor families or large families were more likely to have a low weight-for-age than children from wealthy or small families.     

Outcome of corneal transplantation

Corneal transplantation is a sight restoring surgery done for corneal blindness. The purpose of this retrospective preliminary study is to analyze the outcome of 54 corneal transplantations (for 32 females and 22 males) done in the Department of Ophthalmology between September 1998 and June 2002. The mean follow-up period was 13 months. Hundred percent (6/6) of the keratoconus (KC) and 85.4% of the nonkeratoconus grafts survived at a mean duration of 7.1 months and 16 months respectively. Seven of the 54 grafts (13%) have failed. The causes of graft failure were graft rejction in 4 and bacterial keratitis in 3 cases. Fifty of the 54 cases (92.6%) had a preoperative visual acuity of < 3/60. As a result of the transplantation, the percentage of blind eyes dropped from 92.6% to 21%. The data in this study confirms that corneal transplantation is a reasonably successful procedure in restoring sight for seleted cases of corneal blindness in Ethiopia.     

How accurate is Siriraj stroke score among Ethiopians? A brief communication

In hospitals where emergency neuroimaging is not available, the use of stroke scores has been proposed to distinguish ischemic from hemorrhagic stroke. The aim of this case study is to evaluate the accuracy of SSS among Ethiopian patients and was conducted in the Addis Ababa University teaching Hospital. Between September 1, 2000 and August 31, 2001. A total of 128 patients were admitted with a clinical diagnosis of stroke. 49(38.3%) had a CT scan result that was done within 24 to 72 hours of admission. CT revealed cerebral infarction in 20 (40.8%) patients and hemorrhagic stroke including subarachnoid hemorrhage in 29 (59.2%) patients. SSS was calculated and its sensitivity to diagnose hemorrhage and infarction was 77% and 61.5% respectively with an overall accuracy of 69.2% (Table 1) Its positive predictive values were 67% and 72.7% for hemorrhage and infarction respectively. The study has shown that bedside clinical examination does not always help in distinguishing between cerebral infarction and intracranial hemorrhage.     

Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.     

How reliable is the clinical exam in detecting ocular chlamydial infection?

purpose?To describe the relationship between the clinical exam for trachoma and the polymerase chain reaction (PCR) for ocular chlamydia. methods?One hundred children in a trachoma-endemic area of Ethiopia were examined three times and swabbed twice for PCR analysis. The assays were compared, and an analysis of the variance between exam and PCR was performed. results?Inter-examiner agreement was 0.57 (Cohen's κ), inter-PCR agreement 0.98, and agreement between examiner and PCR, 0.26–0.34. The positive predictive value of the exam in identifying infection was 66%. Inter-examiner variance accounted for 30% of the total variance between the exam and PCR, with the remainder presumably due to an underlying difference in what the exam and PCR measure. conclusions?Despite modest inter-grader reliability and correlation with evidence of infection, the clinical exam is widely used due to its convenience and low cost. Efforts to make laboratory tests for ocular Chlamydia trachomatismore affordable would be useful.     

A systematic literature review of trials of survivorship interventions for women with gynaecological cancer and their caregivers

Core components of survivorship care include treatment of late and long‐term effects, care coordination, promotion of psychological well‐being, health and addressing special populations’ needs. Women affected by gynaecological cancer and their caregivers can experience disease‐specific issues. This review presents an overview of survivorship interventions that have been trialled among this population. Databases were searched in October/November 2016 to identify eligible studies. Titles, abstracts then full‐text were assessed for inclusion by two reviewers until consensus was reached. Data were abstracted using standard tables. Study quality was independently appraised. Twenty‐eight articles were included (five reviews; 23 trials). In regards to late and long‐term treatment effects, our review found mounting high‐level evidence for the effectiveness of psycho‐educational programmes to improve physical aspects of sexual function and for exercise interventions for reducing fatigue. We also found emerging evidence for nurse‐led follow‐up care to improve care coordination and cognitive behavioural therapy to improve psychological wellbeing. There were gaps in the evidence for interventions to effectively address psychosexual issues specific to gynaecological cancer and needs of caregivers. Further research is required to explore strategies to improving psychosexual concerns after gynaecological cancer and the dynamics and supportive care needs of the patient‐partner dyad.     

Socio-economic,trafficking exposures and mental health symptoms of human trafficking returnees in Ethiopia: using a generalized structural equation modelling

Background

Mental health problems among trafficked persons could be the result of concomitantly interwoven effects of various factors. Analyzing the networked relationships concurrently could be a more substantive approach to better understand the role of risk factors in this population. This study aimed to assess the magnitude of mental health symptoms as well as the association among socio-demographic, trafficking related exposure variables, and mental health problems of Ethiopian returnees from trafficking.

Methods

A sample of 1387 returnees who were trafficked via three major human trafficking corridors of Ethiopia were selected consecutively. Data related to socio-economic, trafficking exposure variables, and symptoms of mental illness were collected in personal interviews. Anxiety was measured with a brief measure for generalized anxiety disorder (GAD-7), depression with a patient health questionnaire (PHQ-9), and PTSD with post-traumatic checklist (PCL-C). Generalized structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously.

Results

The prevalence of symptoms of anxiety was estimated at 51.9% (95% CI 49.3–54.6%); PTSD was estimated at 34.5% (95% CI 32.1–37.1%) and depression at 58.3% (95% CI 55.6–60.9%). Restricted freedom of movement had a direct positive effect on anxiety (β?=?1.24, 95% CI 0.97–1.51), depression (β?=?0.94, 95% CI 0.71–1.17) and PTSD (13.00, 95% CI 11.23–14.77). Violence experienced during the trafficking period was a mediator variable and significantly associated with anxiety (β?=?0.46; 95% CI 0.26–0.66) and PTSD (β?=?4.00; 95% CI 2.06–5.94). History of detention had a positive total effect on GAD (total β?=?1.380, 95% CI 1.074–1.687) and PTSD (total β?=?15.63, 95% CI 13.708–17.545), and direct positive effect on depression (β?=?0.89, 95% CI 0.65–1.13).

Conclusion

Ethiopian trafficked persons were highly likely to return with increased levels of mental health symptoms, namely anxiety, depression, and PTSD. Socio-economic and trafficking related exposures mediated by violence were factors affecting mental health symptoms. Thus, in addition to economic re-integrations of victims, strategies should be designed and implemented to address the prevalent mental health problems.