Ethiopia

Persistent dyslipidemia in children is associated with risks of cardiovascular accidents and poor combination antiretroviral therapy (cART) outcome. We report on the first evaluation of prevalence and associations with dyslipidemia due to HIV and cART among HIV-infected Ethiopian children. 105 cART naïve and 215 treatment experienced HIV-infected children were enrolled from nine HIV centers. Demographic and clinical data, lipid profile, cART type, adherence to and duration on cART were recorded. Prevalence and predictors of dyslipidemia were compared between the two groups. Prevalence of dyslipidemia was significantly higher among cART experienced (70.2%) than treatment naïve (58.1%) children. Prevalence of low HDLc and hypertriglyceridemia was higher among cART experienced than naïve children. There was no difference in total hypercholesterolemia and high LDLc levels. Nutrition state was associated with dyslipidemia among cART naïve children. High prevalence of cART-associated dyslipidemia, particularly low HDLc and hypertriglyceridemia, was observed among treatment experienced HIV-infected children. The findings underscore the need for regular follow-up of children on cART for lipid abnormalities.

The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Overall, 60.8% of nurses expressed satisfaction with their job. Job satisfaction levels were significantly higher for female nurses, those older than 29  years and those who had over 10  years of work experience. Satisfaction with remuneration, recognition, professional advancement, features of the work itself, and nurses’ work experiences from 5 to 10  years were significantly associated with overall job satisfaction after controlling for other predictors. The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10  years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.

Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making. Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. The majority (85.3%) knew that TB could be cured. Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges.

This study examined provider barries to uptake of isoniazid preventive therapy (IPT) at 67 government health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services across Ethiopia. Clinician impression that ruling out active TB among HIV patients is difficult was found to be a significant barrier to IPT uptake. Continued advancement of IPT relies greatly on improving the ability of providers to determine IPT eligibility and more confidently care for patients on IPT. Improved clinician support and training as well as development of new TB diagnostic technologies could impact IPT utilization among providers.

Persistent dyslipidemia in children is associated with risks of cardiovascular accidents and poor combination antiretroviral therapy (cART) outcome. We report on the first evaluation of prevalence and associations with dyslipidemia due to HIV and cART among HIV-infected Ethiopian children. High prevalence of cART-associated dyslipidemia, particularly low HDLc and hypertriglyceridemia, was observed among treatment-experienced HIV-infected children. The findings underscore the need for regular follow-up of children on cART for lipid abnormalities.

A cross-sectional study was conducted among 735 new adult tuberculosis (TB) cases registered between January to December 2015 in 10 woredas, equivalent to districts, of southwestern Ethiopia. TB patients waited too long time to initiate anti-TB treatment, reflecting longer periods of morbidity and disease transmission. The delays are attributed to patient, disease and health system related factors. Hence, improving community awareness, and involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce provider delays.

We present Ethiopia's experience in implementing LTBI management. Our objective is to share promising practices and existing opportunities and to suggest specific steps required for further scale up of the services. Our report is based on synthesis of data from secondary sources including official routine reports of Ministry of Health, materials presented at review meetings, and findings from supervisory visits to districts and health facilities. Our results suggest that Ethiopia has made significant strides toward strengthening LTBI management in people living with HIV and among under-five-year-old household contacts of TB patients. The use of contact investigation as entry point for LTBI management could be taken as best practice.

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Between onset of illness and anti-TB treatment course, patients incurred a median of US$201.48. Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median of US$97.62 and US$93.75 during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median of US$21.64 and US$35.02. Patient delay days, provider delay days, number of healthcare facilities visited until TB diagnosis, and TB diagnosis at private facilities independently predicted increased pre-diagnosis cost. Similarly, rural residence, hospitalization during anti-TB treatment, patient delay days, and provider delay days predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

A follow up study among 735 new TB cases registered at health facilities in districts of southwest Ethiopia was conducted from January 2015 to June 2016. Patients reported days elapsed between onset of illness and treatment commencement. The overall treatment success among the treatment cohort was 89.7% respectively among those initiated treatment beyond and within of 30 days of onset of illness. Higher risk of unsuccessful outcome was predicted by treatment initiation beyond 30 days of onset, HIV co-infection, and received treatment at hospital. On the other hand, lower risk of unsuccessful outcome was predicted by weight gain and sputum smear negative conversion the end of second month treatment. Higher risk of unsuccessful outcome is associated with prolonged days elapsed between onset of illness and treatment commencement. Hence, promotion of early care seeking, improving diagnostic and case holding efficiencies of health facilities and TB/HIV collaborative interventions can reduce risk of unsuccessful outcome.

Ethiopia has a high prevalence of tuberculosis (TB) and is one of the countries with the highest burden of multidrug-resistant TB (MDR-TB). This study's purpose was to understand the costs that patients incur in obtaining diagnosis and treatment for MDR-TB. In March 2013, interviews were conducted with 169 MDR-TB patients at three hospitals in Ethiopia to identify the cost to patients and the impact on employment and family income. The average MDR-TB patient incurred a total cost of US$1378, which represented 25 months of a mid-treatment household income of US$54. The impact on the patient's employment and on overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. To help cover the costs, 38% of patients sold some type of property, while 7% leased out property and 41% took out loans, any of which could jeopardize their future financial situation even further. Despite services being officially free of charge, most patients incurred catastrophic costs and suffered significant income loss as a result of obtaining diagnosis and treatment for MDR-TB.

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