Integrating family planning into Ethiopian voluntary testing and counselling programmes

Problem

Governments and donors encourage the integration of family planning into voluntary testing and counselling (VCT) services. We aimed to determine if clients of VCT services have a need for and will accept quality family planning services.

Approach

“Voluntary HIV counselling and testing integrated with contraceptive services” is a proof-of-concept study that interviewed 4019 VCT clients before the addition of family planning services and 4027 different clients after family planning services were introduced. Clients attended eight public VCT facilities in the Oromia region, Ethiopia. The intervention had four components: development of family planning counselling messages for VCT clients, VCT provider training, contraceptive supply provision and monitoring.

Local setting

Ethiopia’s population of 80 million is increasing rapidly at an annual rate of 2.5%. Contraceptive prevalence is only 15%. The estimated adult HIV prevalence rate is 2.1%, with more than 1.1 million people infected. The number of VCT facilities increased from 23 in 2001 to more than 1000 in 2007, and the number of HIV tests taken doubled from 1.7 million tests in 2007 to 3.5 million in 2008.

Relevant changes

Clients interviewed after the introduction of family planning services received significantly more family planning counselling and accepted significantly more contraceptives than those clients served before the intervention. However, three-quarters of the clients were not sexually active. Of those clients who were sexually active, 70% were using contraceptives.

Lessons learned

The study demonstrated that family planning can be integrated into VCT clinics. However, policy-makers and programme managers should carefully consider the characteristics and reproductive health needs of target populations when making decisions about service integration.     

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Background and objectives: The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure (BP) recordings is imprecise and biased and has poor test-retest reliability. The use of intradialytic BP measurements to diagnose hypertension is unknown.Design, setting, participants, & measurements: A diagnostic-test study was done with interdialytic ambulatory BP as reference standard. Index BP recordings tested were: predialysis (method 1), postdialysis (method 2), intradialytic (method 3), intradialytic including predialyis and postdialysis (method 4), and the average of predialysis and postdialysis (method 5). Each index BP was recorded over six consecutive dialysis treatments.Results: There were differences among index BP measurements in reproducibility, bias, precision, and accuracy. Method 4 was the most reproducible (intraclass correlation coefficient = 0.70 for systolic and diastolic BP). All 5 measurement methods overestimated 44-h ambulatory systolic BP. Methods 2, 3, or 4 overestimated ambulatory systolic BP by only a small amount. Method 4 was the most precise and accurate. For diagnosis of hypertension, BP cut-point by method 4 of 135/75 mmHg, had a sensitivity of 90.4% and specificity of 75.9% for systolic BP (area under ROC curve 0.90). Median cut-off systolic BP of 140 mmHg from a single dialysis provides approximately 80% sensitivity and 80% specificity in diagnosing systolic hypertension; a median cut-off diastolic BP of 80 mmHg provides approximately 75% sensitivity and 75% specificity in diagnosing diastolic hypertension.Conclusions: Consideration of intradialytic BP measurements together with predialysis and postdialysis BP measurements improves the reproducibility, bias, precision, and accuracy of BP measurement compared with predialysis or postdialysis measurements.The diagnostic and prognostic significance of hypertension among hemodialysis patients continues to be debated (1,2). Whereas many have suggested that blood pressure (BP) recordings are of little value in managing cardiovascular risk (3,4), others have argued that BP control is important (2,5,6). The accurate measurement of arterial pressure is the essential first step in managing this cardiovascular risk factor, yet the diagnosis of hypertension in hemodialysis patients continues to be a vexing problem (7,8).Although home BP monitoring is a superior tool to diagnose hypertension, typically BP measurements obtained just before and after dialysis are used to diagnose and treat hypertension in hemodialysis patients (8,9). However, predialysis and postdialysis BP measurements are generally inaccurate estimates of ambulatory BP measurements (10). In the dialysis unit, BP measurements are obtained every 30 min during dialysis, primarily to ensure the hemodynamic stability of patients during treatment. But the BP measurements so obtained are usually ignored when making a diagnosis of hypertension. The utility of intradialytic BP measurements in diagnosing hypertension among hemodialysis patients therefore remains unknown.The purpose of our study was to evaluate the usefulness of intradialytic BP in diagnosing hypertension among hemodialysis patients. We measured the utility of intradialytic BP by comparing the dialysis-to-dialysis reproducibility and comparing the bias, precision, and accuracy of intradialytic BP measurements to the reference standard of interdialytic ambulatory BP recordings. Finally, we constructed receiver-operating characteristic (ROC) curves to determine clinically useful cut-points and to assess the diagnostic performance of intradialytic BP recordings.     

Pemphigus in the southeastern United States

BACKGROUND: Our purpose was to review the course and management of pemphigus treated at a tertiary care center in the southeastern United States. METHODS: We describe 30 patients seen at the Emory Clinic from January 1992 to July 1999. RESULTS: Equal numbers of men and women from different ethnic backgrounds were affected. Pemphigus vulgaris was more common than pemphigus foliaceous. Pain, sore throat, and pruritus were the most common presenting symptoms. The mean diagnostic delay was 6 months in patients with pemphigus foliaceous and 4.5 months in patients with pemphigus vulgaris. Hospitalization was required in 47% of patients. Adjuvant therapy in addition to systemic orticosteroids was required in 93%. Herpes gingivostomatitis occurred in 33%. Clinical or total remission was obtained in 33%. CONCLUSIONS: Pemphigus occurs in multiple ethnic groups in the southeastern United States. Appropriate treatment is frequently delayed by lack of prompt diagnosis. The complications of pemphigus and its therapy were significant.     

Susceptibility to polyoma virus tumorigenesis in X-linked immunodeficient (XID) and B-cell deficient (microMT) mice is not increased

Polyoma virus induced tumorigenesis is controlled by T-cells, while B-cells clear virus infection. In order to study if T-cells can override the tumorigenic effect of a long term disseminated viral infection, the tumorigenicity and persistence of polyoma virus in antibody deficient adult and newborn infected X-linked immunodeficient (XID) and microMT mice was followed. In newborn infected XID and CBA control mice (sensitive to tumorigenesis), the frequency of tumor development was similar, and viral DNA was persistent at least 10 months p.i. In polyoma-infected newborn and adult microMT, and control C57BL/6 mice (resistant to tumorigenesis) as well as in adult XID and CBA control mice, no polyoma tumors were observed. Nevertheless, viral DNA was detected in most tissues in all microMT mice throughout the 5-7 month observation period, whereas in the remaining groups of mice persistent viral infection was limited or not detected. We suggest that the tumorigenic potential of an extensive persistent polyoma virus infection can be overcome as long as a functional T-cell system is present.     

The subcellular localization of acetyl-CoA carboxylase 2

Animals, including humans, express two isoforms of acetyl-CoA carboxylase (EC ), ACC1 (M(r) = 265 kDa) and ACC2 (M(r) = 280 kDa). The predicted amino acid sequence of ACC2 contains an additional 136 aa relative to ACC1, 114 of which constitute the unique N-terminal sequence of ACC2. The hydropathic profiles of the two ACC isoforms generally are comparable, except for the unique N-terminal sequence in ACC2. The sequence of amino acid residues 1-20 of ACC2 is highly hydrophobic, suggesting that it is a leader sequence that targets ACC2 for insertion into membranes. The subcellular localization of ACC2 in mammalian cells was determined by performing immunofluorescence microscopic analysis using affinity-purified anti-ACC2-specific antibodies and transient expression of the green fluorescent protein fused to the C terminus of the N-terminal sequences of ACC1 and ACC2. These analyses demonstrated that ACC1 is a cytosolic protein and that ACC2 was associated with the mitochondria, a finding that was confirmed further by the immunocolocalization of a known human mitochondria-specific protein and the carnitine palmitoyltransferase 1. Based on analyses of the fusion proteins of ACC-green fluorescent protein, we concluded that the N-terminal sequences of ACC2 are responsible for mitochondrial targeting of ACC2. The association of ACC2 with the mitochondria is consistent with the hypothesis that ACC2 is involved in the regulation of mitochondrial fatty acid oxidation through the inhibition of carnitine palmitoyltransferase 1 by its product malonyl-CoA.     

Social and behaviour change communication to improve child feeding practices in Ethiopia

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.     

Measurement of reproductive health indicators in Ethiopia: A mixed method study

Aim

Various reproductive health (RH) indicators have been formulated and used to measure RH services and status. Despite their widespread use, the measurement of these indicators has never been explored in a systematic manner. This study aimed to examine methods and methodologies in the measurement of common RH indicators in the Ethiopian context.

Subjects and Methods

A mixed-method design, comprising in-depth expert interviews, the abstraction of information from relevant public documents and an analysis of peer-reviewed literature, was used. Information from these three sources was then organised and synthesised using a thematic approach.

Results

Until now, routine health information system and demographic and health survey have been the primary sources for RH indicators in Ethiopia. A number of improvements have recently been made in data collection and aggregation methods; however, the focus has been more on the coverage of services than the quality of data. We noted that variations were observed in indicator definition between the two data sources and, as a consequence, in their estimates. It was found that many of the inherent limitations in the measurement of RH indicators could be addressed by making small modifications to the data sources and the reporting formats. Data quality concerns mainly occur at the point of data collection although there are also issues with data aggregation, dissemination and use.

Conclusion

There is a gap in the measurement of the quality and continuity of RH services. Many of the limitations and data quality concerns in the measurement of RH indicators could be resolved with minimal improvements to the current health information system.