7 research outputs found
Prevalence and factors associated with laboratory-confirmed cases of select enteric infections in three Ethiopian communities, 2018-2022
No full textEnteric diseases are major contributors to morbidity and mortality worldwide; however, in Ethiopia, information on the prevalence of enteric infections and associated trends is limited. Understanding the epidemiology of enteric infections is necessary for determining disease burden and allocating resources. The objective of this study was to estimate the prevalence of laboratory-confirmed infections associated with select parasitic and bacterial pathogens in three Ethiopian hospitals, assess trends, and identify associated factors. Laboratory and patient metadata for stool samples tested at clinical laboratories in Addis Ababa, Gondar, and Harar in Ethiopia from 2018 through 2022 were collected and digitized. Descriptive statistics were used to summarize laboratory results and assess trends in sample submission and infection. Prevalence of laboratory-confirmed infection and 95% confidence intervals were estimated by pathogen using binomial proportion testing and logistic regression. Univariate and multivariable logistic regression were used to identify associated factors. A total of 48,643 samples were included in the analysis. Prevalence estimates for parasitic infection were 5.23% [95%CI:4.87%,5.62%], 17.48% [95%CI:17.04%,17.93%], and 15.69% [95%CI:14.57%,16.85%] in Addis Ababa, Gondar, and Harar, respectively. Prevalence estimates for bacterial infection were 0.25% [95%CI:0.07%,0.65%] and 7.59% [95%CI:5.97%,9.50%] in Addis Ababa and Gondar, respectively; stool samples were not tested for bacterial pathogens in Harar. Stool sample submission and enteric infection detection varied by year at each site. Age, season, and year of submission were identified as factors associated with the detection of enteric pathogens in stool samples. Prevalence estimates differed across study sites and testing was not conducted for many enteric pathogens associated with diarrhea. Additional research to understand the scope of enteric infection is necessary for resource allocation toward robust diagnostic procedures and increased laboratory capacity for stool testing. Efforts to mitigate enteric infection should utilize seasonal and geographic infection trends to anticipate areas in need of additional resources
The heterogeneous association between education and the adoption of safe food handling practices in Ethiopia
No full textBACKGROUND: Foodborne disease is a great concern to low- and middle-income countries. To prevent illness and death, intervention strategies need to be implemented across the food safety system and should include promoting the adoption of safe food handling practices. The positive association between education and health has been well-established, and one possible mechanism is that education may improve health by encouraging individuals to adopt more appropriate protective practices. Decisions regarding adoption of these practices may also be influenced by the food safety risks individuals face, the trade-offs they make to maximize utility, or behavior biases which may be correlated with education. This study aims to estimate the heterogeneous association between education and the adoption of safe food handling practices among people facing different levels of food safety risk. METHODS: Models were constructed based on the Grossman health model and risk as well as behavior bias theories. Multivariate logistic regression models were estimated to explore the heterogeneous associations using data from a community survey conducted in Ethiopia. Agricultural household status and livestock presence were used as proxies to represent varying risk levels. Average marginal effects were estimated to provide a more accessible interpretation of the results. RESULTS: Results showed that the association between education and certain safe food handling practices was positive among individuals in households assumed to face higher food safety risks, while the association was less pronounced (or even negative) for those facing lower levels of risk. We observed that secondary education attainment was associated with a 20 percentage points increase (p \u3c 0.01) in the probability of washing hands compared to the reference group (illiterate) in agricultural households. However, for non-agricultural households, secondary education was associated with a 10 percentage points decrease (p \u3c 0.05) in probability. Similar patterns were found for washing surface. CONCLUSIONS: Education is associated with increased adoption of safe food handling practices among individuals facing higher food safety risks. This has important implications for developing targeted policies focused on individuals most susceptible to foodborne diseases. Future policies aimed at increasing the adoption of safe food handling practices should also integrate individuals\u27 decision-making processes and behavior biases in the context of varying risk levels
Lessons and Implementation Challenges of Community Health Information System in LMICs: A Scoping Review of Literature
No full textBACKGROUND: Accurate and timely information on health intervention coverage, quality, and equity is the foundation of public health practice. To achieve this, countries have made efforts to improve the quality and availability of community health data by implementing the community health information system that is used to collect data in the field generated by community health workers and other community-facing providers. Despite all the efforts, evidence on the current state is scant in Low Middle Income Countries (LMICs). OBJECTIVE: To summarize the available evidence on the current implementation status, lessons learned and implementation challenges of community health information system (CHIS) in LMICs. METHODS: We conducted a scoping review that included studies searched using electronic databases like Pubmed/Medline, World Health Organization (WHO) Library, Science Direct, Cochrane Library. We also searched Google and Google Scholar using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to CHIS were included. The review included all studies published until February 30, 2022. Two authors extracted the data and resolved disagreements by discussion consulting a third author. RESULTS: A total of 1,552 potentially relevant articles/reports were generated from the initial search, of which 21 were considered for the final review. The review found that CHIS is implemented in various structures using various tools across different LMICs. For the CHIS implementation majority used registers, family folder/card, mobile technologies and chalk/white board. Community level information was fragmented, incomplete and in most cases flowed only one way, with a bottom-up approach. The review also indicated that, technology particularly Electronic Community Health Information System (eCHIS) and mobile applications plays a role in strengthening CHIS implementation in most LMICs. Many challenges remain for effective implementation of CHIS with unintegrated systems including existence of parallel recording & reporting tools. Besides, lack of resources, low technical capacity, shortage of human resource and poor Information Communication Technology (ICT) infrastructure were reported as barriers for effective implementation of CHIS in LMICs. CONCLUSION: Generally, community health information system implementation in LMICs is in its early stage. There was not a universal or standard CHIS design and implementation modality across countries. There are also promising practices on digitalizing the community health information systems. Different organizational, technical, behavioural and economic barriers exist for effective implementation of CHIS. Hence, greater collaboration, coordination, and joint action are needed to address these challenges. Strong leadership, motivation, capacity building and regular feedback are also important to strengthen the CHIS in LMICs. Moreover, CHIS should be transformed in to eCHIS with integration of different technology solutions. Local ownership is also critical to the long-term sustainability of CHIS implementation
Environmental risk factors associated with community diarrheal disease in Ethiopia
No full textBACKGROUND: Diarrhea is a major contributor to mortality in sub-Saharan Africa, where access to improved sanitation and clean water is limited. Identifying factors associated with diarrhea across geographical regions and age groups can inform resource allocation toward water infrastructure, healthcare, and disease mitigation. The objective of this study was to identify environmental risk factors associated with diarrhea in the general population across multiple communities in Ethiopia. METHODS: A prospective cross-sectional study was conducted in three regions in Ethiopia from October 2021-October 2022. REDCAP mobile app was used to collect data during face-to-face interviews using a structured, pretested questionnaire. Descriptive statistics characterized household environmental exposures. Univariate and multivariable logistic regression were used to identify factors associated with diarrhea. RESULTS: A total of 2,436 households participated in the study. Of these, 10.3% of households reported at least one case of diarrhea during the previous four weeks. Household animal ownership varied by site, with Addis Ababa reporting the lowest animal ownership and Harar reporting the highest ownership. Across all sites, pit latrines without covers were the most common sanitation facility. Water piped to yard was the most frequent source of drinking water and most households did not use treated water (boiled/filtered) when handling food. No environmental factors were associated with diarrhea in Addis Ababa. In Gondar, drinking water from unprotected wells was associated with increased odds of diarrhea [COR:4.81(95%CI:2.03,11.43)]. Dry season was associated with decreased odds of diarrhea compared to short [COR:0.42(95%CI:0.24,0.75)] and long rains seasons [COR:0.55(95%CI: 0.34,0.88)]. In Harar, drinking water from communal taps was associated with increased odds of diarrhea [COR:2.02(95%CI:1.32,3.09)]. CONCLUSION: Multiple environmental factors for diarrhea were identified. Given the variation in factors by site, strategies for intervention and management should be community-specific. These factors can be managed through improved water treatment, sanitation practices, and educational programs focused on proper hygiene. Efforts to manage these factors can potentially reduce the burden of diarrheal diseases
Increasing smear positive tuberculosis detection using a clinical score - A stepped wedge multicenter trial from Africa
No full textBackground: The Bandim TBscore is a clinical score that predicts treatment outcome in Tuberculosis (TB) patients and proved useful as an indicator of which healthcare-seeking adults to refer for sputum smear microcopy. We aimed to test in a randomized trial if the TBscore could be used to enhance the detection of smear positive (SP) TB. Methods: We carried out a stepped wedge cluster-randomized trial at six health centers in Bissau, GuineaBissau, and Gondar, Ethiopia. The primary outcome was diagnostic yield for SP TB. Secondary outcomes were successful treatment and effect on overall 12 months mortality. The study was registered at the Pan African Clinical Trials Registry (PACTR201611001838365). Results: We included 3571 adults. Overall, there was no effect of the intervention on SP PTB detected (OR 1.39 (95%CI 0.75 - 2.56). Analysis stratified by country, showed that the TBscore increased case detection in Gondar (OR 4.05 (95%CI 1.67 - 9.85)) but no effect was found in Bissau (OR 0.47 (95%CI 0.22 - 1.05)) where take-up was much lower. Overall mortality decreased during the intervention (HR 0.31 (95%CI 0.13-0.72)). Conclusion: Using the TBscore for triage before smear microscopy may improve case detection and decrease mortality if there is sufficient laboratory capacity to increase sputum smears. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.Funding Agencies|Novo Nordisk FoundationNovo Nordisk FoundationNovocure Limited; Scandinavian Society for Antimicrobial Chemotherapy Foundation; Gondar University; Swedish research councilSwedish Research CouncilEuropean Commission</p
Prevalence of Shiga toxin-producing Escherichia coli, Salmonella, and Campylobacter species among diarrheal patients from three major hospitals in Ethiopia.
No full textDiarrheal illness remains a major global health challenge, causing millions of deaths annually. Non-typhoidal Salmonella (NTS), Shiga toxin-producing Escherichia coli (STEC), and Campylobacter species (CAMPY) significantly contribute to this burden. Given the limited information on these pathogens in Ethiopia, this study aimed to estimate their prevalence among diarrhea patients in Ethiopia and identify risk factors for infection. A cross-sectional study was conducted from October 2021 to November 2022 in three hospitals in Ethiopia (Addis Ababa, Gondar, and Harar). Sociodemographic characteristics, clinical signs and symptoms were collected from study participants using a structured questionnaire. Stool samples were tested for NTS, STEC, and CAMPY using standardized methods. The prevalence of targeted pathogens was estimated overall and by study sites. Univariable and multivariable logistic regression were used to identify associated factors. A total of 2,331 patients were enrolled. The overall prevalence of NTS, STEC (stx only), STEC (stx + eae), and CAMPY was 1.29% (95%CI: 0.91, 1.84), 12.56% (95%CI: 11.29, 13.98), 3.43% (95%CI: 2.77, 4.25), and 4.46% (95%CI: 4.61, 8.00), respectively. Harar had the highest prevalence of all the pathogens compared to Addis Ababa and Gondar. Odds of NTS in Harar were over 10 (AOR: 10.43: 95%CI: 2.95, 69.20) and 3.5 times (AOR: 3.57: 95%CI: 1.50, 9.90) higher than that in Addis Ababa and Gondar, respectively. Odds of STEC (stx only) in the dry (AOR: 1.97: 95%CI: 1.37, 2.90) and long rainy (AOR: 1.80: 95%CI: 1.20, 2.69) seasons were nearly twice the odds in the short rainy season. Odds of CAMPY infection decreased by 3.29% (AOR: 0.97: 95%CI: 0.95, 0.98) with every one-year increase in age. Moreover, the odds of CAMPY infection for rural residents (AOR: 1.93, 95%CI: 1.15, 3.19) were nearly twice that of urban residents. This is the first study to estimate the prevalence of NTS, STEC, and CAMPY simultaneously across all age groups and diverse regions in Ethiopia, revealing significant variations. Results can be used to understand the burden of disease, inform clinical management and risk mitigation strategies to reduce illness in Ethiopia
Factors Associated with Uptake of Routine Measles-Containing Vaccine Doses among Young Children, Oromia Regional State, Ethiopia, 2021
No full textRecommended vaccination at nine months of age with the measles-containing vaccine (MCV1) has been part of Ethiopia’s routine immunization program since 1980. A second dose of MCV (MCV2) was introduced in 2019 for children 15 months of age. We examined MCV1 and MCV2 coverage and the factors associated with measles vaccination status. A cross-sectional household survey was conducted among caregivers of children aged 12–35 months in selected districts of Oromia Region. Measles vaccination status was determined using home-based records, when available, or caregivers’ recall. We analyzed the association between MCV1 and MCV2 vaccination status and household, caregiver, and child factors using logistic regression. The caregivers of 1172 children aged 12–35 months were interviewed and included in the analysis. MCV1 and MCV2 coverage was 71% and 48%, respectively. The dropout rate (DOR) from the first dose of Pentavalent vaccine to MCV1 was 22% and from MCV1 to MCV2 was 46%. Caregivers were more likely to vaccinate their children with MCV if they gave birth at a health facility, believe that their child had received all recommended vaccines, and know the required number of vaccination visits and doses. MCV2 coverage was low, with a high measles dropout rate (DOR). Caregivers with high awareness of MCV and its schedule were more likely to vaccinate their children. Intensified demand generation, defaulter tracking, and vaccine-stock management should be strengthened to improve MCV uptake
