435 research outputs found
HIV/AIDS-Related Mortality in Addis Ababa City Administration
No full textMeasurement of the impact of HIV/AIDS on mortality is of fundamental importance to develop
programmes to mitigate the effects of the epidemic in Ethiopia, similar to other countries in subSaharan Africa. Little is known about the HIV/AIDS-related mortality in the general population
of the country and especially in Addis Ababa. A prospective surveillance of deaths at burials in
Addis Ababa is initiated, since information on vital events in Ethiopia, as in most of sub-Saharan
Africa, is defective. In this study, verbal autopsy (VA) and clinician review techniques were used
to assess the cause specific mortality (CSM) in general and HIV/AIDS-related mortality in
particular, in the general population of Addis Ababa.
Since February 8, 2001 a prospective surveillance started at all the available and functioning
burial sites (n=70) in the rural and urban localities of Addis Ababa, collecting information on
name, sex, age, address, date of burial and presumed cause of death of the deceased. Burial sites
included: all 51 orthodox churchyards, eight mosque-based, seven municipal-based, two
community-based “Yesenbete mahber”, one catholic-based, and one Jewish “Bete-Israel”
cemetery. Verbal autopsy (VA) was conducted at 414 selected households, three to four months
after death, involving 10 teams of two interviewers. Two independent clinicians reviewed and
assessed the VA questionnaires and assigned causes of death. Hospital records for those who
died in Addis Ababa hospitals were traced and assessed and compared with VA-derived causes
of death.
In three months, 5,133 deaths were registered (45% females and 55% males). The CDR was
estimated yielding to 8.23 per 1000 population per year. Neonatal mortality and infant mortality
was 29/1000 and 42/1000 live births, respectively. For females, the peak percentage of deaths
was 11% in the age group 25-29 years, whereas for males the peak percentage of deaths was
9.6% in the age group 35-39 years. A total of 414 deaths were selected for VA: 44, 108 and 262for neonates, children and adults, respectively. Response rate for the three age strata ranged
between 66-76%. The major cause of death was TB/HIV/AIDS-related disease in 127 deaths
(41.4%) of which 96 deaths (48%) were adults and 31 deaths (29.0%) were under-12 year olds.
Of the 96 (48%) adult deaths due to TB/HIV/AIDS, 48 (50%) were males and 48 (50%) females,
with a male to female ratio of 1:1. Being single and age group of 60-69 years showed
significantly higher risk of mortality due to TB/HIV/AIDS.
In the absence of vital events registration in Addis Ababa, surveillance for burials appeared to be
a good method to estimate mortality. Through VA and physician review, the impact of
TB/HIV/AIDS on mortality was estimated. Although epidemiological models revealed similar
estimates, counting of deaths and providing numbers of the Addis Ababa population that die of
TB/HIV/AIDS may stimulate better policy makers and public health workers to act immediately
to this devastating epidemic.
It is recommended that the surveillance for burials should continue for long-term basis, as it may
provide additional information on mortality (i.e. seasonal variation, and geographic differences
within Addis Ababa), and may also allow for analysis of mortality trends
BMC Public Health
No full textBackgroundChanges in socioeconomic status, lifestyle and behavioral factors among the urban population in Ethiopia is resulting in a shift in the causes of mortality.MethodsA total of 49,309 deaths from burial surveillance were eligible for verbal autopsy for the years 2006 to 2009. Among these, 10% (4,931) were drawn randomly for verbal autopsy of which 91% (4,494) were adults of age 6515 years. Verbal autopsies, used to identify causes of death and frequency of risk factors, were completed for 3,709 (83%) of the drawn sample.ResultsAccording to the results of the verbal autopsy, non-communicable diseases caused 1,915 (51%) of the total adult deaths, while communicable diseases and injuries caused 1,566 (42%) and 233 (6%) of the deaths respectively.ConclusionThe findings from the analysis suggest that public health interventions targeting HIV/AIDS, tuberculosis, as well as non-communicable diseases need to consider behavioral factors related to alcohol, tobacco and khat consumption. We also recommend large scale national level studies to further assess the specific contributions of these risk factors to the burden of mortality in the country.20135U22/PS022179_05/PS/NCHHSTP CDC HHS/United States23835193PMC3708758691
Preventing Chronic Disease (PCD)
No full textIntroductionIn Ethiopia, lack of reliable data on causes of death prevents full understanding of the double mortality burden of communicable and noncommunicable diseases. Our objective was to help bridge this research gap by analyzing surveillance data on causes of death in Addis Ababa.MethodsBurial surveillance identified 58,010 deaths in Addis Ababa from 2006 through 2009, of which 49,309 were eligible for verbal autopsies, a method of interviewing caregivers of the deceased about the circumstances, signs, and symptoms preceding death. We randomly selected 10% from the eligible sample, of whom 91% were defined as adults (aged 6515 y). Verbal autopsies were completed and causes of death were assigned for 3,709 adults.ResultsOverall, 51% (95% confidence interval [CI], 49.7%-52.9%) of deaths were attributed to noncommunicable diseases, 42% (95% CI, 40.6%-43.8%) to communicable diseases, and 6% (95% CI, 5.5%-7.0%) to injuries. Similar proportions of male and female deaths were caused by noncommunicable and communicable diseases. Adults aged 55 to 84 were more likely, and those aged 15 to 44 were less likely, to die from noncommunicable diseases compared with the age group 85 or older. Premature deaths (defined as earlier than age 65) from noncommunicable diseases were mainly due to certain cancers, type 1 and type 2 diabetes, hypertension, stroke, and genitourinary disease.ConclusionNoncommunicable diseases are the leading cause of death among adults in Addis Ababa, where the health care system is still geared toward addressing communicable diseases. Health policy attention is needed to remedy this situation. This observed double mortality burden is unlikely to be unique to Addis Ababa and provides new insight into the epidemiological transition in urban Ethiopia. Nationwide studies should be conducted in Ethiopia to examine the pattern of epidemiological transition and the magnitude of double mortality burden.5U22/PS022179_05/PS/NCHHSTP CDC HHS/United State
Burial Surveillance in Addis Ababa: Providing Aids Related Mortality Data for Monitoring Program Impact
No full textBackground: The Addis Ababa Mortality Surveillance Program was established in 2001 in
Addis Ababa, the capital of Ethiopia as part of the Master of Public Health (MPH) work of TA,
the Principal Investigator. In the last three decades, HIV/AIDS emerged as major health
problems of adults, especially in developing countries. Reliable cause-specific mortality data
were crucial resources for health monitoring, service planning and prioritization for the
prevention and treatment of the HIV/AIDS epidemic.
Objective: The major objective of this study was to monitor the impact of HIV/AIDS on adult
mortality and the mitigating effect of ART on adult HIV/AIDS-mortality in the population of
Addis Ababa.
Methods: To address the aforementioned objective, various research methods were
triangulated. As baseline data, prospective surveillance of burials was instituted in February 8,
2001 at all cemeteries in Addis Ababa, the capital of Ethiopia; and all deaths were registered
continuously. Trained cemetery-based clerks registered the socio-demographic profile
including address and lay reports of cause of death of the deceased from close relatives or
friends performing the pre-requisites for burial. Pairs of trained interviewers conducted verbal
autopsy interviews on random samples of burial records. By tracing the residential house of the
deceased, a next of kin of the deceased was interviewed on the symptoms and events during the
illness preceding the death using a standard verbal autopsy questionnaire. An independent
panel of physician reviews and InterVA model were used interchangeably on the completed
verbal autopsy information and probable underlying causes of death were assigned. A reference
standard (gold standard) was constructed using prospective surveillance of patients in Zewditu
Memorial Hospital in Addis Ababa, whereby patients were approached for an HIV-test (2003-
2004). Patients with known HIV-serostatus who either died in the hospital or elsewhere after
discharge were linked with the burial surveillance.
One hundred and ninety three adult hospital cases were matched with the burial records for
which verbal autopsy interviews were conducted and the 167 had complete verbal autopsy
information (response rate=86%). An independent panel of physicians reviewed the 167 casesand assigned probable underlying causes of deaths. The same data was also compared with the
InterVA model to interpret the verbal autopsy interviews.
A range of analyses were used to obtain cause-specific mortality fractions: Firstly, by
dichotomizing the reference standard and the physician verbal autopsy diagnoses into AIDSand Non-AIDS, sensitivity and specificity were computed to validate the physician verbal
autopsy diagnosis with the reference standard in diagnosing HIV and AIDS-related deaths.
Secondly, using the Cohen’s Kappa Statistic (1) the agreement between two independent
physician verbal autopsy reviewers in diagnosing HIV and AIDS-related causes of deaths was
evaluated. Thirdly, the level of HIV-related mortality reduction after the introduction of large
scale antiretroviral therapy was also determined using burial surveillance data in combination
with the verbal autopsy physician diagnoses. The period before 2005 was defined as the preART era and that from 2005-2009 as the ART era. HIV-related specific mortality fractions
were computed by age, sex and year of burial to examine the mortality trends before and during
the ART era. Fourthly, sensitivity, specificity and CSMFs were computed using the interpreted
verbal autopsy information by the InterVA model as indicators of the diagnostic accuracy of
the InterVA model
Results: The major findings obtained in this study revealed that triangulating burial
surveillance with the verbal autopsy method and surveillance on hospital-based patients
constitutes a unique data source for studying population-level cause-specific mortality patterns
and in particular for adult HIV-and AIDS-specific mortality; and the effectiveness of ART on
HIV/AIDS-related mortality. By reviewing verbal autopsy information, physicians accurately
identified AIDS-related deaths with an acceptable level of sensitivity and specificity of 0.88
(95% CI: 0.80–0.93) and 0.77 (95% CI: 0.64–0.87), respectively, with high level of agreement
between the first two physicians with K ranging from the early years 0.60 - 0.80. A significant
reduction in HIV/AIDS-specific mortality was observed in the adult population after the
introduction of ART: HIV/AIDS- related deaths in 2009 were 33% fewer than in 2001; and the
proportion of HIV-related deaths was reduced from 44% in the pre-ART to 20% in the ART
era. The InterVA model yielded sensitivity and specificity of 0.82 (95% CI: 0.74–0.89) and
0.76 (95% CI: 0.64–0.86), respectively, in diagnosing HIV/AIDS. The model also estimatedAIDS-specific mortality fraction at 61.7% (95% CI: 54–69%), that was close to 64.7% (95%
CI: 57–72%) in the reference standard.
Conclusions and Recommendations: In a setting where vital registration is absent and
hospital statistics are incomplete, the methods used in this study served as a partial substitute
for a full-fledged vital registration system. The accurateness and agreement of the panel of
physicians in diagnosing HIV/AIDS-related deaths based on verbal autopsy information was
demonstrated. Burial data combined with information from verbal autopsy interviews showed a
significant reduction in HIV/AIDS-related deaths during the provision of free ART. The
InterVA model performed well in diagnosis to be an easy to use and cheap alternative to
physician review for assessing HIV/AIDS-related mortality. Expansion of burial surveillance
coupled with verbal autopsy and hospital surveillance is recommended in similar settings,
where vital registration is non-existent, to track large-scale population level interventions.
Verbal autopsy diagnoses provided by physicians are reliable and thus a single verbal autopsy
coder is practical for programmatic purposes in countries where there is critical shortage of
doctors. Utilization of the InterVA model should be considered in times researchers sought
cost-reduction
BMC Public Health
No full textBackgroundEthiopia is encountering a growing burden of non-communicable diseases along with infectious diseases, perinatal and nutritional problems that have long been considered major problems of public health importance. This retrospective analysis was carried out to examine the mortality patterns from communicable diseases and non communicable diseases in public and private hospitals of Addis Ababa.MethodsApproximately 47,153 deaths were captured over eight years (2002\u20132010) in forty three public and private hospitals of Addis Ababa, Ethiopia. Data collectors (43 hospital clerks) and coordinators (3 nurses) had been extensively trained on how to review hospital death records. Information obtained included: dates of admission and death, age, sex, address, and principal cause of death. Only the diseases responsible for deaths are taken as the cause of death. Cause of death was coded using International Classification of Diseases (ICD-10) and data were double entered. Diseases were classified into: Group I (communicable diseases, maternal conditions and nutritional deficiencies); Group II (non-communicable causes); and Group III (injuries). Percentages, proportional mortality ratios, 95% confidence intervals (CI) and Adjusted odd ratios (OR) were calculated.ResultsOverall, 59% of the deaths were attributed to Group I diseases, and 31% to Group II diseases and 12% to injuries. Nearly 56% of the males and 68% of the females deaths were due to five leading causes (conditions arising during perinatal period, HIV/AIDS, tuberculosis, cardiovascular diseases and respiratory infections). Significantly larger proportions of females died from Group I (67%) and Group II diseases (32%) compared with males (where the respective proportions were 52% and 30%). Significantly higher proportion of males (17%) than females (6%) were dying from Group III diseases. Deaths due to Group I diseases decreased while those due to Group II diseases increased with age. Overall Group I diseases and HIV/AIDS, tuberculosis and still birth mortality in particular have showed decreasing trend while Group II and III increasing over time. Double burden in mortality was highly observed in the age groups of 15\u201364 years. Those aged >45 years were dying more likely with non-communicable diseases compared with children. Children aged below 15 years were 16 times more likely to die from communicable, perinatal and nutritional conditions compared with elders. Mortality variation with age has been identified between public and private hospitals.ConclusionsThe results of the present study shows that, in addition to the common Group I causes of death, emerging group II diseases are contributing to high proportions of mortality in the public and private hospitals of Addis Ababa, Ethiopia. Thus, priority should be given to the prevention and management of conditions arising during perinatal period such as low birth weight and still birth, HIV/AIDS; tuberculosis, respiratory infections, cardiovascular diseases, malignant neoplasm, chronic respiratory diseases and road traffic accident. The planning of health resources and activities should take into account the double burden in mortality due to Group I and Group II diseases. This calls for strengthening approaches towards the control and prevention of non-communicable diseases such as cardiovascular and malignant neoplasm.20125U22/PS022179_05/PS/NCHHSTP CDC HHS/United States23167315PMC3520706691
Historical narratives and civic subjectification in post-conflict times
No full textDossier: Violencia política, desaparición forzada y memoriaEsta revisión bibliográfica busca responder a la pregunta: Cuál es el rol de las narrativashistóricas en la construcción del ciudadano post-conflicto? La autora explora algunas de lasimplicaciones sociopolíticas al contar una narrativa particular para darle sentido al pasado,presente, y futuro, y como herramienta crucial en la subjetivación de la ciudadanía del post-conflicto. Esto es, la creación de nuevas subjetividades, roles, expectativas, y códigos deconducta consistentes con la aspiración de una reconstrucción nacional. La autora profundiza entres áreas: 1) el ciudadano post-conflicto normativo 2) los diferentes tipos de narrativas históricasy su uso para la formación ciudadana 3) la participación y respuesta de los jóvenes frente a lasnarrativas históricas y la subjetivación cívica. Las conclusiones señalan algunos de los desafíos yoportunidades que Colombia –como uno de los casos más recientes de transición política– puedeafrontar con relación a las narrativas históricas, la ciudadanía post-conflicto, y los esfuerzos deconstrucción de paz.This literature review seeks to answer the question: What is the role of historical narratives inconstructing the post-conflict citizen? The author explores some of the sociopoliticalimplications of telling a particular narrative as a tool for making sense of the past, the present,and the future, as well as a key element in the subjectification of the post-conflict citizenry. Thisis, the creation of new subjectivities, roles, expectations, and codes of conduct consistent withthe goal of national reconstruction. The author delves into three main areas: 1) the normativepost-conflict citizen 2) the different types of historical narratives and their deployment forcitizenship formation 3) youth’s engagement and responses to historical narratives and civicsubjectification. Conclusions point to some of the challenges and opportunities that Colombia –as one of the most recent cases of political transition– might face in relation to historicalnarratives, post-conflict citizenship, and peacebuilding efforts
BRAND IMAGE ANALYSIS IN SMALL MEDIUM BUSINESS AT ARAYA CAKE SHOP IN PEKANBARU CITY
No full textThe research conducted by the author aims to determine the analysis of brand image that occurs in small and medium businesses at the Araya cake shop in the city of Pekanbaru. Cake combines its outlets with the concept of a cafe, Araya Cake has received permission from the Ministry of Health and the owner of Araya Cake makes a patent for registering its business with the Intellectual Property Rights Institute (HKI) and also Araya Cake has collaborated with various agencies and individuals. The type of research is descriptive with quantitative methods. The sampling technique used incidental sampling technique with a total sample of 34 respondents, the data used in the study were obtained through observation, interviews, questionnaires and literature studies, the types of data sources used in the study were primary data and secondary data. good category, for the second indicator, namely the user image, based on the results of the questionnaire obtained, the user image is also in a good category, according to the choice of the respondent in the agree category which has the highest score, for the product image indicator, it is in the category strongly agree with the largest score of
60.0 , so it can be concluded that the product image is in the very good category. Keywords: Brand image, small and medium business, Araya cak
BMC Med Res Methodol
No full textBackgroundVerbal autopsy has been widely used to estimate causes of death in settings with inadequate vital registries, but little is known about its validity. This analysis was part of Addis Ababa Mortality Surveillance Program to examine the validity of verbal autopsy for determining causes of death compared with hospital medical records among adults in the urban setting of Ethiopia.MethodsThis validation study consisted of comparison of verbal autopsy final diagnosis with hospital diagnosis taken as a \u201cgold standard\u201d. In public and private hospitals of Addis Ababa, 20,152 adult deaths (15 years and above) were recorded between 2007 and 2010. With the same period, a verbal autopsy was conducted for 4,776 adult deaths of which, 1,356 were deceased in any of Addis Ababa hospitals. Then, verbal autopsy and hospital data sets were merged using the variables; full name of the deceased, sex, address, age, place and date of death. We calculated sensitivity, specificity and positive predictive values with 95% confidence interval.ResultsAfter merging, a total of 335 adult deaths were captured. For communicable diseases, the values of sensitivity, specificity and positive predictive values of verbal autopsy diagnosis were 79%, 78% and 68% respectively. For non-communicable diseases, sensitivity of the verbal autopsy diagnoses was 69%, specificity 78% and positive predictive value 79%. Regarding injury, sensitivity of the verbal autopsy diagnoses was 70%, specificity 98% and positive predictive value 83%. Higher sensitivity was achieved for HIV/AIDS and tuberculosis, but lower specificity with relatively more false positives.ConclusionThese findings may indicate the potential of verbal autopsy to provide cost-effective information to guide policy on communicable and non communicable diseases double burden among adults in Ethiopia. Thus, a well structured verbal autopsy method, followed by qualified physician reviews could be capable of providing reasonable cause specific mortality estimates in Ethiopia. However, the limited generalizability of this study due to the fact that matched verbal autopsy deaths were all in-hospital deaths in an urban center, thus results may not be generalizable to rural home deaths. Such application and refinement of existing verbal autopsy methods holds out the possibility of obtaining replicable, sustainable and internationally comparable mortality statistics of known quality. Similar validation studies need to be undertaken considering the limitation of medical records as \u201cgold standard\u201d since records may not be confirmed using laboratory investigations or medical technologies. The validation studies need to address child and maternal causes of death and possibly all underlying causes of death.20125U22 PS022179_05/PS/NCHHSTP CDC HHS/United States22928712PMC3568023691
Analisis Citra Merek Pada Usaha Kecil Menengah Di Toko Araya Cake Di Kota Pekanbaru
No full textThe research conducted by the author aims to determine the analysis of brand image that occurs in small and medium businesses at the Araya cake shop in the city of Pekanbaru. Cake combines its outlets with the concept of a cafe, Araya Cake has received permission from the Ministry of Health and the owner of Araya Cake makes a patent for registering its business with the Intellectual Property Rights Institute (HKI) and also Araya Cake has collaborated with various agencies and individuals. The type of research is descriptive with quantitative methods. The sampling technique used incidental sampling technique with a total sample of 34 respondents, the data used in the study were obtained through observation, interviews, questionnaires and literature studies, the types of data sources used in the study were primary data and secondary data. good category, for the second indicator, namely the user image, based on the results of the questionnaire obtained, the user image is also in a good category, according to the choice of the respondent in the agree category which has the highest score, for the product image indicator, it is in the category strongly agree with the largest score of 60.0 , so it can be concluded that the product image is in the very good category
Life table estimates of adult HIV/AIDS mortality in Addis Ababa
No full textBackground: With the expansion of antiretroviral treatment in the country, HIV prevalence figures alone, are expected to become insufficient for monitoring the HIV/AIDS epidemic.Objective: To develop life table method for estimating AIDS mortality based on surveillance of deaths at burial sites in Addis Ababa.Methods: An empirical life table for 2001 based on observed deaths and the projected population is matched with model life table on an age range where AIDS mortality is minimal. Excess mortality in adulthood is attributed to AIDS.Results: Between 54.7 and 62.4% of adult deaths in Addis Ababa (age 2064) are attributed to AIDS. The absolute numbers of AIDS deaths for the year 2001 is estimated between 7,000 and 9,000. Estimates of the absolute number of deaths are sensitive to underreporting of burials and therefore on the conservative side. In terms of the share of AIDS attributable mortality, women are worse affected than men. The absolute number of AIDS deaths is higher for men than for women.Conclusion: Life table methods corroborate earlier estimates of AIDS mortality based on other methodologies. Burial surveillance data used as an input to life table methods may be used for monitoring the demographic impact of AIDS as well as the population level effects of the provision of antiretroviral treatment. The Ethiopian Journal of Health Development Vol. 20(1) 2006: 3-
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