Emergency contraception: knowledge and practice of Gondar University students, northwest Ethiopia

OBJECTIVES: To assess the knowledge and practice of Gondar University students regarding emergency contraceplion. PATIENTS AND METHODS: A university based cross-sectional study was conducted in the University of Gondar in May 2004. All undergraduate students of the university were included in the study. A self-administered anonymous questionnaire was used for data collection. RESULTS: A total of 2323 students (1764 males & 559 females) responded to the questionnaire. Five hundred fifty eight students (24.0%) thought that there are methods that can be used to prevent pregnancy when a woman had unprotected sex. Overall, 437 students (18.8%) knew the correct methods of emergency contraception (pill or IUCD). Of those who mentioned pill as the only method of emergency contraception, 285 (73.3%) said the pill should be used within 72 hours after unprotected sex. Only one student used pill as emergency contraceptive. Students in the health field have 6.8 times higher knowledge on emergency contraception compared to students of FBE. Generally, there was an increasing trend in the knowledge of students when their age and year of study increases. Married or divorced students had 3.36 times higher knowledge when compared with never married students. CONCLUSION: In general, except students in the health field, other students have low awareness about emergency contraception. Emergency contraceptive user rate is very low. Even in those who are aware of emergency contraception, the information they have regarding the methods that can be used and the timing of emergency contraception was not sufficient. Students should be provided with appropriate information regarding emergency contraception and access to emergency contraception should be improved in the university.     

Polio outbreak response in Ethiopia

BACKGROUND: Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. OBJECTIVES: This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. DESIGN: A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. SUBJECTS: All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. RESULTS: Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. CONCLUSION: Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a one-year period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security.     

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.

     

Disclosure History Among Persons Initiating Antiretroviral Treatment at Six HIV Clinics in Oromia,Ethiopia, 2012–2013

HIV status disclosure can help patients obtain support which may influence treatment adherence and subsequent healthcare needs. We examined the extent of disclosure and correlates of non-disclosure among 1180 adults newly initiating antiretroviral treatment (ART). While 91 % of those in a relationship shared their status with their partners, 14 % of the overall sample had not disclosed to anyone. Non-disclosure was positively associated with older age; control over household resources; and concerns about unintended disclosure, life disruptions, and family reactions. Knowing other HIV-positive people and longer time since diagnosis were associated with lower odds of non-disclosure. Most respondents reporting disclosure experienced supportive responses, frequently including decision to get an HIV test by confidants who had not known their own status. Although HIV status disclosure prior to ART initiation was high, some individuals cited concerns about unintended disclosure, gossip, and partner violence, and may benefit from additional disclosure support.     

Regions on adenylyl cyclase that are necessary for inhibition of activity by βγ and Giα subunits of heterotrimeric G proteins

The two large cytoplasmic domains (C1 and C2) of adenylyl cyclases (AC), when expressed separately and mixed together, reconstitute enzyme activity that can be regulated by various modulators. Therefore, we have used the C1 or its C1a subdomain and C2 regions from type I AC (ACI) and type V AC (ACV) to identify the region on ACI that interacts with beta gamma subunits of heterotrimeric G proteins. In addition, we also used a chimeric C1 domain (VC1aIC1b) in which the C1a region was derived from ACV and the C1b region was from ACI. By mixing the C1 or C1a or VC1aIC1b domains with C2 regions of ACI or ACV, we have shown that the C1a region (amino acids 236-471) of ACI is sufficient to observe beta gamma-mediated inhibition of enzyme activity, which is stimulated by either constitutively active G(salpha) (G(salpha)*) or Ca(2+)/calmodulin (CaM). Although the C1b region and C2 domain of ACI were by themselves not sufficient for inhibition of activity by beta gamma subunits, the presence of both of these regions formed another beta gamma interaction site that was sufficient to observe G(salpha)*- or Ca(2+)/CaM-stimulated activity. Inhibition of AC activity attributable to interaction of beta gamma subunits at either of the two sites was blocked by a peptide (QEHA) that has previously been shown to inhibit the effects of beta gamma on various effectors. Moreover, the C1 region of ACI was sufficient to observe G(ialpha1)-elicited inhibition of Ca(2+)/CaM-stimulated activity. Although the C1a region of ACV was sufficient for inhibition of activity by G(ialpha1), the presence of C1b region from either ACI or ACV increased sensitivity to inhibition by the inhibitory G protein. Thus, the inhibitory influences of G(ialpha1) are mediated on the C1 regions of both ACI and ACV. The effects of beta gamma on ACI can be mediated by interactions with the C1a region and a beta gamma interacting site formed by the C1b and C2 domains of this enzyme.     

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

Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources.     

Quality of family planning service in Dembia district, north west Ethiopia

OBJECTIVE: Ethiopia is one of the countries with high population and population growth rate. Providing quality family planning service is the major strategy to control the population growth. Since there were no studies conducted in Northwest Ethiopia regarding quality of family planning services, this study was conducted with the objective of assessing the quality of family planning services in Dembia district, Northwest Ethiopia. MATERIALS AND METHODS: A cross sectional community and health institution based study was conducted in April 2004. One hundred sixty five women were included in the household survey. For the assessment of availability of different family planning methods, technical competence of service providers, and appropriate constellation of services, the District Health (Office, one health center, three health stations, and 8 Community Based Reproductive Health Agents were selected. RESULTS: The maximum number of available methods in the sites was 3. All the 165 clients were informed how and when the method should be used but the information provided regarding the side effects of the methods was insufficient. In all the service delivery points there were 9 (40.9%) service providers who got additional training on family planning. Except one health officer, there was no one who can insert IUCD. All the five health professionals in the health center and 2 (28.6%) health professionals in the three health stations can inject depo provera. One hundred and six (64.2%), and 50 (30.3%) of the clients rated the providers relation with the clients as very good and good, respectively. All the clients had follow up appointments. One hundred forty two (86.1%) of the current users have used the method for one year and over. The working days for all government health institutions in the district are from Monday to Friday, 8 hours a day. CONCLUSION: Adequate choice of contraceptives were not available and the information provided to the clients was insufficient. Based on the findings it is recommended to increase the number of methods; provide sufficient information to clients; increase community based reproductive health service sites; and give additional training for the providers so that they can give quality family planning service in their area.     

Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007–2013

Background

Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.

Methods

Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose.

Results

Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death.

Conclusion

Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.