Ethiopia

The aim of this study was to assess the prevalence of MDR-TB and associated risk factors in West Armachiho and Metema districts of North Gondar. A cross-sectional study was conducted between February 1 and June 25, 2014. A total of 124 consecutive smear-positive pulmonary TB patients were included in the study. Socio-demographic and possible risk factor data were collected using a semi-structured questionnaire. Drug susceptibility testing was first performed for rifampicin using GeneXpert MTB/RIF. For those rifampicin resistant strains, drug susceptibility testing was performed for both isoniazid and rifampicin to identify MDR-TB. Of 124 smear-positive pulmonary TB patients, 117 (94.4 %) were susceptible to rifampicin, while 7 (5.7 %) were confirmed to be resistant to rifampicin and isoniazid. History of previous treatment was significantly associated with MDR-TB. Maximizing early case detection and treatment, strengthening TB infection control activities and proper implementation of DOTS are recommended to reduce the burden of MDR-TB.

Abstract Family caregivers play a critical role in caring for children living with HIV, however, there is little knowledge about their experiences. The aim of this study was to illuminate the family caregivers' lived experiences of caring for a child when he or she has been diagnosed with HIV and enrolled to antiretroviral treatment. Qualitative interviews with 21 family caregivers of 21 children diagnosed with HIV were analyzed using an inductive design with a hermeneutic phenomenological approach. The caregivers' experience were articulated in 5 subthemes under the main theme of "Surviving overwhelming challenges": "Committed care-giving," "Breaking the family life," "Caring burdens," "Confronting conflicts," and "Living with worry." Despite the difficult situation the family caregivers experienced with extensive worry, caring burdens, and disrupted family and social networks, they were committed caregivers. They were empowered by their belief in God but also by their strong belief in the child's treatment and support from healthcare workers. The healthcare system needs to consider possible ways to support the family caregivers during child's HIV diagnosis and treatment initiation as part of a continuum of care.

In 2011, Ethiopia introduced a strategy of symptomatic tuberculosis (TB) screening for patients attending out-patient services to increase identification of presumptive TB. We assessed implementation and factors affecting symptomatic TB screening in 86 health centres in the Amhara Region. A quarter (28%) of the health centres in this study had poor symptomatic TB screening practices in the out-patient services. Strengthening multidisciplinary teams and expanding partner support are recommended to improve TB screening practices in Ethiopia.  

The aim of this study was to assess the incidence and nature of adverse drug events (ADEs) in hospitalized children at a teaching hospital in Ethiopia. We studied 600 children hospitalized at Jimma University Specialized Hospital between 1 February and 1 May 2011. Fifty-eight ADEs were identified, with an incidence of 9.2 per 100 admissions, 1.7 per 1000 medication doses and 9.4 per 1000 patient-days. One-third of ADEs were preventable; 91% caused temporary harms and 9% resulted in permanent harm/death. A strategy to prevent ADEs, including education of nurses and physicians, is of paramount importance.

We sought to reduce the service needs of people living with HIV by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach. We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals, (3) improvement in client referrals was accompanied by a decrease in patient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool.

To determine the yield of a household contact investigation for tuberculosis (TB) under routine programme conditions. The objective of this study was to determine the yield of a household contact investigation for tuberculosis (TB) under routine programme conditions.Between April 2013 and March 2014, TB clinic officers in Amhara and Oromia regions, Ethiopia, conducted symptom-based screening for household contacts of 6,015 smear-positive TB (SS+ TB) index cases. We calculated the yield in terms of number needed to screen (NNS) and number needed to test (NNT). The NNS to detect a TB case all forms and SS+ TB was respectively 40 and 132. The NNT to diagnose a TB case all forms and SS+ TB was respectively 2.4 and 8. The yield of the household contact investigation was over 10 times higher than the estimated prevalence in the general population; household contact investigations can serve as an entry point for childhood TB care.

The HIV epidemic among Ethiopian children appears neglected in national programs (children ART coverage was only 12% in 2013). This paper estimates the country burden of HIV in older children and investigates the prevalence of HIV in orphans and vulnerable children (OVC) households. Our analysis estimated the population of HIV-positive children under 15 years old to be 160,000 in 2013. The majority of children (81.6%) were aged 5 to 14 years. The estimated number of orphans due to AIDS was 800,000. The empirical data from almost 10,000 OVC under 18 years showed 11.9% were HIV-positive, the majority of whom were between 5 and 10 years old with no significant difference between males and females. There is a large population of children living with HIV in Ethiopia, the magnitude of which has not been previously recognized. The majority were vertically infected and never identified nor linked into treatment. OVC represent a reachable group which could account for a substantial proportion of the HIV-infected older children. We recommend that HIV programs urgently synergize with social protection sectors and address these children with HIV testing and related services.

The intention of this study was to determine prevalence and associated factors with adherence to highly active ART among people living with HIV/AIDS (PLWHA) at the Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia. A cross-sectional study design with systematic random sampling was conducted using a structured adherence questionnaire among 422 respondents from the hospital. Adherence was defined as not missing a single ART dose during the 30-day period prior to filling out the self-report. Among the participants, 95.5% were taking their medication without missing a dose. Factors such as having emotional or practical support positively encouraged ART adherence. However, users of traditional, complementary, and alternative medicine (TCAM) had a nearly five times higher risk for ART nonadherence (p = 0.05) than those not using TCAM. Strengthening emotional and practical support for PLWHA and integrating TCAM with the proper use of ART are vital to enhance ART adherence.

Poor socio-economic conditions fuel seasonal migration of adult males from Northwestern Ethiopia, but behavioral and other migration-related changes increase their vulnerability to HIV. This study examined risky sexual behaviors and associated factors that may lead to increased HIV infection vulnerability among migrant laborers in Metema District, Ethiopia. A community-based cross-sectional study was conducted from July 8–18, 2013 at farms with migrant laborers. We enrolled 756 participants through multistage random sampling. Of the participants, 582 (77%) migrant workers had had sexual intercourse in their lifetimes and 68% (397/582) reported non-marital sexual intercourse in the preceding six months. Of these, 74% reported sexual intercourse with commercial sex workers (CSWs), 49% reported having transactional sex, 49% reported unprotected sexual intercourse with CSWs, and 69% reported multiple sexual partners in the preceding six months (mean = 2.9 ± 0.7). Being aged between 20 and 29 years, aged 30 years or older, having received of HIV prevention information in the preceding six months, and staying longer on the farm were factors significantly associated with condom use at last non-marital sexual intercourse. Teenaged respondents aged , those who had not received HIV information in the preceding six months, or those who had stayed on the farm for ≤2 months were less likely to have used condoms at their last non-marital sexual intercourse. Moreover, having daily income above US$5, paying for most recent sexual intercourse, and drinking alcohol before last sexual intercourse were significantly associated with having multiple (≥2) sexual partners during the preceding six months. We concluded that seasonal laborers commonly exhibit risky sexual behaviors likely to increase their vulnerability to HIV infection. Unprotected and multiple sex partners in these populations pose transmission risks to seasonal laborers, their wives, and future sexual partners. The findings support the need for targeted HIV prevention campaigns designed for seasonal workers and their sexual partners.

The Ethiopian HIV epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic, a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim is also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation, and disease stage upon presentation. The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

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