Browsing by Author "Ali, Ahmed (PhD)"

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    Analysis of Spatiotemporal Dynamics and Associated Factors of Malaria: a Comparative Study Around Gilgel-Gibe Hydroelectric Dam and Control Villages, Jimma Zone, Southwest Ethiopia
    (Addis Abeba Universty, 2015-02) Sena, Lelisa; Ali, Ahmed (PhD)
    Background Analysis of spatiotemporal dynamics of malaria data of health care systems along with climatic variables and assessment of the intervention tools provides important insights into the changing malaria situation, which might guide adjustments of malaria program activities and priorities of malaria research topics. The objectives of this study were to compare trends of malaria, to ana-lyze spatiotemporal dynamics of malaria in the Gilgel Gibe Hydroelectric dam (GGHD) site, to examine the role of climatic variables on malaria, to determine possession and utilization of long lasting insecticidal nets (LLINs/ITNs), and to evaluate the prevalence of malaria around GGHD and a control site. Materials and methods Records of malaria cases over eight years period in health facilities of the two sites were re-viewed along climatic variables. Malaria episode and meteorological data were registered on excel spreadsheet separately. Summary of the data were exported to SPSS version 20 for Win-dows and linked together using unique identifiers. Prevalence of malaria was analyzed and de-scribed by person, place and time using line graphs. Spearman correlation coefficient was ana-lyzed to explore the correlation between climatic variables and malaria episodes. Malaria epi-sodes of the two sites was compared using odds ratios. Spatial analysis was carried out by linking malaria episodes data of GGHD site with the Gilgel Gibe Health and Demographic System (GGHD-HDSS) data that have been geo-referenced. Pois-son regression model was applied to estimate odds ratios of the malaria episodes among buffer zones and altitude ranges of the site using the STATA statistical software version 12. A household survey was conducted during peak malaria transmission season to assess possession and utiliza-tion of LLINS by households. Similarly, blood survey was conducted during the same season us-ing rapid diagnostic test (RDT). Both data of the household and blood surveys were entered into EpiData entry II database and exported to SPSS version 20 for Windows for analysis. Binary and multinomial logistic regressions were employed to identify predictors of LLIN ownership and uti-lization. xiv Results Two-third of the 163,918 registered malaria episodes were slide/RDT confirmed cases. Plasmo-dium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) accounted for 54.6% (60.4% in GGHD site and 52.3% in control site) and 41.6% (33.6 in GGHD site and 44.7% in control site), the rest (3.8%) was mixed species infections. P. falciparum and P. vivax were twice and nearly trice times more likely to occur in the control site compared to GGHD site. Several peaks of ma-laria transmission seasons were noted in the control site whereas only two small one main trans-mission peaks were observed in the GGHD. The probabilities of infections by both P. falciparum and P. vivax were high in the control site than in the GGHD site in all age categories. Children from 10 to 14 years were the most affected followed by children below the age of 10 years. In the GGHD site, 45.0% of the P. falciparum episodes were registered within one-kilometer ra-dius of the Dam. Yet, as distance increases from the GGHD, the odds of P. falciparum occur-rence increases significantly up to five kms, when adjusted for population density. Positive and significant correlation between P. falciparum occurrence and altitude was also noted. Again; as the distances from the GGHD increases, the occurrence of P. vivax increases. On the other hand, increasing altitude was negatively and significantly associated with the occurrence of P. vivax malaria. At the GGHD site, moderate correlations were seen at months 2 and 3 lags with both rainfall and relative humidity. There were only weak positive correlations at month 4 for rainfall and months 2 through 4 for relative humidity at the control site. The overall coverage of LLINS was 56.6% ( in GGHD site and control site). Higher number of HHs from GGHD site reported to have at least one LLINS (OR = 2.2 & P < 0.001) whereas high-er number of HHs from control site reported to have two or more LLINS (OR = 2.1 & P < 0.001). Factors that independently affect the possession and utilization of LLINS were found to be age of HH heads, HH RWI, accessibility to all weather roads, proximity to health facilities. From the total 2269-screened individuals, only 17 were tested positive for malaria. Since all the cases were from District based site, the prevalence in the site was 1.4% whereas it was zero in the site where the Community-based IRS was applied. xv Conclusions Malaria prevalence was higher in the control than the GGHD site. The present finding did not show evidence of excess malaria burden in the GGHD over the study period. Yet, the fact that the trend of malaria prevalence in GGHD exhibited increasing slope, the identification of malaria cases near GGHD and significantly high prevalence of P. falciparum near the GGHD imply the possible role of the dam in maintaining malaria hot spot. Weak/absence of linear correlation be-tween malaria episodes and climatic variables does not prove absence of the association between malaria and climate variables. The blood survey positivity rate was very low suggesting the need for additional study before concluding whether the community based model of IRS works effec-tively to control malaria. In GGHD site, irrespective of the low prevalence noticed, the transmis-sion of malaria might have been maintained associated with the Dam. Recommendations  Regarding the increment of P. falciparum with altitude and that of P. vivax with distance from reservoir of dams, further exploration is needed.  There is a need to consider additional factors such as normalized difference vegetation index and the physico-chemical nature of the breeding sites of mosquitoes.  Attention needs to be given to the poor, distant and inaccessible households in the efforts of malaria intervention programmes. Well-tailored information, education and communi-cation (IEC) is needed to address the problem of non-users of LLINs.  Applicability of the community-based model of IRS need to be further explored in different localities to fully replace the district based model of IRS in the future.  Patient records at health facilities should include family identity (ID) so that spatial anal-ysis of diseases can be carried out by linking cases history to the family. Key words: Climatic variables, Ethiopia, Gilgel Gibe, hydroelectric dam, malaria trend, spatiotemporal dynamics, bed nets
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    Assessment of Antiretroviral Therapy Adherence and Associated factors Among Adult HIV-Infected Persons in Oromia Special Zone Surrounding Finfine, 2017
    (Addis Ababa University, 2017-05) Mirkena, Kassahun; Ali, Ahmed (PhD)
    Background: The introduction of combination ART has resulted in striking reductions in HIV related mortality. Numerous reports have documented that the key to success of the HAART is the ability and willingness of HIV-positive individuals to adhere to ART regimens, and at least 95% adherence is required for the prescribed ART doses to be fully effective. However, pertinent data regarding the issue has been lacking in the study area. Objectives: The main aim of this study was to assess the level of adherence and associated factors among adult HIV patients who were receiving ART from health centers of Finfine Surrounding Oromia Special Zone. Methods: A facility based retrospective cross-sectional study was conducted from October 2016 to May 2017 on 389 patients’ selected using systematic sampling technique. The study focused on assessment of ART adherence & its associated factors among Adult on ART whose ages were greater than 18 years & above. A pre tested & structured questionnaire was used to collect the necessary data & the collected data were entered into Epidata version 3.1 & analyzed using SPSS version 21. Then the magnitude of association between the different variables in relation to the adherence to ART was assessed through chi square test & then further analysis done using multivariate regression to confirm the effects of independent variables. During analysis, the significance level was set at 95% CI and P-value of <0.05 & the results were presented using tables containing frequency and percentage. Results: The adherence rate of the study patients was 80.5%. Majorities were females (66.3%), their median age was 36 and mean duration of treatment 3.3 years. Disclosing own status to sexual partners or others [(AOR 6.6, 95% CI 3.58,8.32)], doing assessment & counseling on adherence [(AOR 13, 95% CI 5.94,15.13)] & presence of regular ARV drug supply [(AOR 5.4, 95% CI 3.91,9.72)] were significantly associated with ART adherence. Conclusion: The self-reported ART adherence level in this study is low compared to the expected standard. Disclosing own status to sexual partners or others, doing assessment & counseling on adherence , & regular ARV drug supply were associated with patients’ adherence status.
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    Assessment of Breast Self Examination Practice and Associated Factors among Women Between 20 Up To 70 Years Attending on the Selected Public Health Centers in Addis Ababa, Ethiopia, 2015
    (Addis Abeba Universty, 2015) Mekonen, Mahlet; Ali, Ahmed (PhD)
    Back ground: Breast cancer is the leading cause of cancer death in women age between 40 and 55 year worldwide. The Study estimated that 70% of all breast cancer cases worldwide will be in low and middle resource countries by 2020. In Ethiopia breast cancer is the second most often occurring cancer types having a lion's share for higher maternal deaths in the country. Breast self-examination is one of the methods used for early detection of breast cancer. In resource scarce countries like Ethiopia, Breast self-examination is promoted for early detection of breast cancer to prevent related morbidities and mortalities. OBJECTIVE: To assess the magnitude of Breast Self-Examination practice and associated factors among women between 20 up to 70 years attending the selected public health centers in Addis Ababa, Ethiopia, 2015. METHODS: A health facility based cross-sectional study was conducted from March-April/2015 among women between 20 up to 70 years attended in selected public health centers in Addis Ababa, Ethiopia, 2015. Health centers were selected by simple random sampling technique and the study participants were selected using Systematic Random Sampling Technique. Data were collected by using a structured and pretested questionnaire. Data transferred from the Epi info database to SPSS database using stat transfer for analysis. Logistic regression analysis was fitted and odds ratios with 95% Confidence intervals and p-values were computed to identify factors associated with the practice of Breast self-examination. Result: There were 406 respondents, which gives a 96% response rate from the expected 422. From the 14 question designed to assess BSE knowledge of the respondents 88(21.7%) scores the median seven and above. Below one fourth 46(11.3%) of the respondents were ever practiced BSE, from that only 24(6%) regularly practiced. The most common reason for not practicing BSE, they didn’t know how doing it 224 (55.2%). Women who have knowledge of BSE two times more likely practice BSE (Knowledgeable for BSE AOR 2.227 [1.135 – 4.3]) and also women who have confidence to do BSE six times more likely practice BSE (Have perceived confidence AOR 5.645[2.493 – 12.7]). Therefore, the two variables were that statically significant association with the practice of BSE. Conclusion: This study revealed a low level of ever practice BSE and from that few of them regularly practice Breast self-examine. Thus warrant to the concerned bodies for creation of breast cancer awareness campaigns and screening programs at all levels of the health sector to promote early detection and diagnosis in the prevention of breast cancer in women in Ethiopia.
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    Assessment of Determinants of Survival in adult HIV Patients after Initiation of Antiretroviral therapy in Nekemte Referral Hospital, Wollega, West Ethiopia. A Retrospective Cohort Study
    (Addis Abeba Universty, 2012-05) Teshome, Mitiku; Ali, Ahmed (PhD)
    Introduction: Studies identified different determinants of survival which includes, viral load, WHO clinical staging, CD4 cell count, body mass index (BMI), total lymphocyte count (TLC), ART adherence and baseline hemoglobin level. Even if these determinants of survival had been identified, there is no single proven model of determinants for predicting mortality of PLHIV and these determinants are dynamic and change over time due to improving quality of care and support and specific interventions like nutritional interventions. Furthermore, the optimal time to start treatment for HIV/AIDS has been a controversial issue since the introduction of HAART. Objective: To assess determinants of survival in patients living with HIV after starting ART. Methodology: A retrospective cohort study was conducted in Nekemte Referral Hospital. A total of 416 patients’ records enrolled between 2005 to January, 2012 were reviewed consecutively by using patients’ ART unique identification number as a reference. Univariate analysis was used to describe patient’s baseline characteristics. Life table was used to estimate survival after initiation of ART, and log rank test was used to compare survival curves. Cox proportional-hazard regression was used to calculate the bivariate and adjusted hazard rate and then determined independent determinants of time to death. Results: Four hundred sixteen adult patients on ART were followed for a median of 47 months. The mean age was 33.6 years (SD=9.04) and the median weight of the study subjects at the initiation of ART was 51 kg (IQR, 45kg-58kg). The estimated mortality was 4%, 5%, 6%, 7%, and 7% at 6, 12, 24, 36 and 48 months respectively. After adjustment, factors such as, age≥40 AHR=3.364(1.211, 9.348, p=0.020), lower baseline hemoglobin level AHR=0.490 (0.300, 0.801, p=.007), and poor ART adherence AHR=132.3(29.9, 585.8, p<0.001) were confirmed as significant independent determinants of less survival after controlling for other factors while, single marital status AHR=0.285(0.1, 0.84, p=0.023) was protective of HIV mortality. Conclusion: This study has identified the independent significant determinants of less survival in patients living with HIV after initiation of ART which included older age, low baseline hemoglobin level, and poor ART adherence, while single marital status was protective of HIV mortality. These determinants should be taken into account by health care providers to enhance better clinical outcomes.
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    Assessment of Effectiveness of Insecticide Treated Bednets for Malaria Prevention in Under-five Children of Aletawondo Woreda, Southern Ethiopia
    (Addis Abeba Universty, 2005-06) Wassie, Eshetu; Ali, Ahmed (PhD)
    Background: A Meta analysis of all randomized controlled trials showed that insecticide treated net use has an overall protective efficacy against all -causes of child mortality and malaria disease episodes of 18% and 50%, respectively. Frequent washing, lack of retreatment, inconsistent use, other social and technical factors were shown to influence efficacy of bednets at field trials. To date, however, experience with local factors influencing the effectiveness of ITN programs remains very limited and it is not known whether the impact of treated nets in the context of well controlled randomized trials can be replicated under program conditions in all set-ups. Objective: To assess the effectiveness and influencing factors of ITNs in preventing clinical malaria in under five children in Aletawondo Woreda, Sidama Zone, SNNPR. Methods: A community based retrospective cohort study was conducted on a sample of 342 under five children (171 exposed and 171 unexposed/comparison group) residing in Chucko Town & surrounding rural kebeles where there was ITN distribution. A precoded, pretested structured questionnaire was employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies. The collected data was daily checked for completeness and consistency and it was entered into computer database. An internal comparison was also conducted to assess factors influencing effectiveness of bednets among those with history of malaria (cases) and without history of the disease within the exposed cohort. Other appropriate statistical tests were done and interpretations were made accordingly. Result: The history of malaria attack from September to December 2004 among reported regular ITNs users was 43.5% less than in those who didn't use/own bednet. This was statistically significant (OR=0.565 95%CI 0.346-0.925 p=0.023). The household factors that were found to influence the effectiveness of ITNs were large family size, keeping livestock inside living room, using a bednet obtained a year or more, absence of retreatment of the bednet for more than 12 months, presence of hole/tears in the bednet, frequently washing the bednet and reported history of rolling out of the child from the bednet during night time. Conclusions & Recommendations: Despite lots of programmatic deficiencies, ITNs are effective in preventing clinical malaria in under-five children. Based on these, appropriate recommendations are forwarded. Key Words: (Clinical malaria, Under -five child, Insecticide treated mosquito net use, Effectiveness, retrospective cohort, nested case control Design, Influencing household factor)
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    Assessment of effectiveness of the different IEC Interventions in improving awareness and reducing Stigma related to HIV/AIDS among High School adolescents in Awassa, Southern Ethiopia
    (Addis Abeba Universty, 2007-07) Bekele, Alemayehu; Ali, Ahmed (PhD)
    Background: Stigma and discrimination are common human reactions to disease. HIV/AIDS related stigma and discrimination negatively affect preventive behaviors, HIV test-seeking behavior, and careseeking behavior, quality of care and perception of PLWHA by communities, families, and partners. Objective: The aim of this study was to assess the presence of HIV/AIDS related misconceptions and stigma in adolescents and determine the effectiveness of different IEC interventions in reducing the HIV/AIDS related stigma and to ascertain long-term effects of the IEC interventions. Materials and Methods: Interventional study was employed from January to March 2007 on the adolescents of the four high school students using four different IEC Interventions, namely interpersonal communication, pamphlets, educational video and the combination of the three Interventions. Immediate post intervention and follow up assessments for misconceptions and stigmatizing attitudes were carried out. Result: Misconceptions on HIV transmission/prevention were 0-52.3%. Stigmatizing attitudes ranged from 0-65.2%. Multivariate logistic regression analyses showed Grade, Religion, beliefs in HIV transmission by witchcraft and HIV transmission by feeding on uncooked egg/meat of chicken that swallowed used condom were significantly associated with avoidant behavioral intentions, AOR, 2.23(95% CI 1.2-4.1), AOR, 0.43 (95% CI, 0.22-0.82), AOR, 0.22(95%CI, 0.06-0.77), AOR, 3.5, (95%CI, 1.4-8.8) and AOR, 2.1(95% CI, 1.1-3.9) respectively. Regarding beliefs in HIV transmission/prevention, variables like coughing/sneezing, feeding on raw egg of a chicken that swallowed used condom and practicing sex with virgin girls were found to be statistically significantly associated with blaming attitude AOR, 4.8(95% CI, 1.5-15.4), AOR, 2.7(95% CI 1.5-4.9) and AOR, 3.8(95% CI, 1.1-13.4) respectively. Residence, fathers’ education, Television ownership, transmission by witchcraft, healthy looking person can have HIV, HIV prevention by having sex with virgin girls and PLWHA had multiple sexual partners were found to be determinants of coercive attitude AOR, 0.2(95% CI 0.05-0.80) AOR, 6.4(95% CI, 1.02-40.42), AOR, 5.9(95% CI, 1.0-34.6), AOR, 12.9(95% CI 2.8-58.4), AOR, 6.1 (95% CI, 1.7-22.0), AOR, 22.3(95% CI, 5.1-97.1)and AOR, 2.9(95% CI, 1.02- 8.45) respectively. Mothers’ education and HIV transmission by eating with PLWHA were also found to be determinants of the negative sympathetic feelings to PLWHA AOR, 2.1 (95% CI, 1.10-4.14) and AOR, 2.75(95% CI, 1.04-7.30) respectively. IEC interventions were effective in reducing HIV stigma and discrimination. ANOVA (F statistics) revealed that the interventions were effective, ANOVA, 17.484 (p-value<0.0001). Conclusion: Misconceptions on the transmission/prevention of HIV and associated stigmatizing and discriminatory attitudes were prevalent among the adolescents. Remarkable reduction in the HIV ix related misconceptions, stigmatizing and discriminatory attitudes were observed using the combined interventions. Hence, campaigns using combined IEC interventions on HIV/AIDS need to be intensified to dispel some of the prevailing misconceptions and the associated stigma and discrimination among high school adolescents.
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    Assessment of Factors Affecting HIV Voluntary Counseling and Testing Uptake among Bahir Dar University Students, Bahir Dar Town
    (Addis Abeba Universty, 2008-07) Hiruy, Nebiyu; Ali, Ahmed (PhD)
    Since the first case of AIDS was recognized in America in 1981, HIV/AIDS has spread rapidly throughout the world. Different studies showed that a great proportion of people living with HIV/AIDS do not know that they carry the virus making VCT service underutilized. However, the reasons for young people for not taking VCT services are not well known. Moreover, University students fall within the most sexually active and high HIV risk group. This study tried to assess the reasons why Bahir Dar University students prefer to or not to take HIV test. This study was conducted from March - April 2008 among Bahir Dar University undergraduate students to assess the factors affecting voluntary counseling and testing uptake. The study design was descriptive cross-sectional. Stratified random sampling was applied to select samples. A standardized questionnaire was used after pre-test to collect quantitative data. Data entry and analysis was done using SPSS. A total of 360 students participated in the study of whom 255 were males. Majority (90.6%) were within the age range of 18 to 23 years. The mean age was 21.26(± sd 1.987). Most of the respondents (95.3%) were single. The study revealed that 38.6% of the study participants had undergone HIV test. Stepwise multivariate analysis showed that being female, second year or above, starting sexual intercourse and knowledge about VCT location were positively associated likelihood of having had HIV testing. Respondents with stigmatizing attitude were less likely to utilize the service. The study shows that stigma still plays a major role as a barrier for utilization of HIV testing services. The University should intensify activities pertaining to curbing stigma and discrimination so that the willingness of students for HIV counseling and testing could be paralleled with actual use of HIV testing.
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    Assessment of factors affecting willingness to HIV counselling and testing among patients presenting with the conventional Sexually Transmitted Infections (STIs) in Addis Ababa
    (Addis Abeba Universty, 2007-07) Alemayehu, Legese; Ali, Ahmed (PhD)
    There is ample scientific evidence that a person with an untreated STI, particularly those inducing ulcers or discharge, is at an increased risk of passing on or acquiring HIV during sexual intercourse. HIV CT for STI cases is thus an important tool in the public health response to HIV/AIDS. A descriptive, cross-sectional study, involving 422 STI cases, was conducted to assess factors affecting willingness towards HIV CT among patients presenting with the conventional STIs in Addis Ababa, from December 2006 to April 2007. STI patients were consecutively selected during an outpatient visit in ten government health centers which were purposively selected mainly on the basis of their high STI case load. A pre-tested, interviewer administered, structured questionnaire was applied for data collection. OR with 95% CI was used to measure the degree of association between associated factors and willingness towards HIV CT and, logistic regression analysis was done to identify predictors of willingness towards HIV CT. Overall, 73.9% of STI patients said that they would be willing to undergo HIV CT at the time or 3 months after their STI diagnosis. Furthermore, 97.4% and 71.8% of STI patients had heard about HIV/AIDS and STIs, respectively. Nearly 93% of STI patients knew at least one prevention method, and 61.2% identified all the three major methods for preventing HIV/AIDS. Overall, 43.8% of the STI patients had at least one misconception, and 38% had comprehensive knowledge about HIV/AIDS. Moreover, 74% of STI patients said that they never used condoms during the previous 12 months. The proportion of those who reported ever had HIV test was 45%. More than half (61.5%) of the STI patients reported ‘no or low chance’ of acquiring HIV and the main reason they gave was they trusted their partner. One or more stigmatizing attitudes also prevailed in 33.3% of the STI patients. Ever tested for HIV, being in the age group of 15-34 years, and perceiving small or moderate chance of contracting the HIV infection were found out to be significantly associated with willingness towards HIV CT. The findings of this study indicated the need for promotion and expansion of sustainable provider initiated HIV CT with subsequent follow up to STI patients as part of a continuum of services and support, and intensive patient-centered risk reduction counseling for STI cases during the initial visit to health care facilities.
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    Assessment of Hepatitis B Seroprevalence and Associated factors in Kality prison Addis Abeba Ethiopia
    (2016-12) Girma, Asnakech; Ali, Ahmed (PhD)
    Background; Hepatitis is a general term meaning inflammation of the liver and can be caused by different viruses. Hepatitis B virus (HBV) is DNA virus causing hepatitis in human. The prison setting has been shown to be a high risk environment for blood borne viral infections like hepatitis B virus infections. The aim of this study was to assess the prevalence and associated factors of hepatitis B virus infections among prison inmates in Kality Prison. Objectives: Determining the prevalence and associated factors of HBV infections among prison inmates at Kality Prison in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from January 2016 – October 2016 data on socio demographic and HBV risk factors were collected using a semi-structured questionnaire. Two ml of venous blood samples were collected and serum was tested for hepatitis B virus infections using commercially available rapid test kits. Data were analyzed using SPSS version 21.0. Logistic regression analysis was used and a P value < 0.05 was considered statistically significant. Results: A total of 457 prison inmates, 347 males and 100 females, with a mean age of 37.9 years were participated. Twenty-two participants (4.8%) were positive for hepatitis B surface antigen. Our study revealed that inmates who had an experience of sharing sharp materials were about 2.6 times (AOR =2.59; 95% CI: 1.04-6.43) at higher risk of hepatitis B seropositive, compared to inmate who had no such experience. On the other hand, prison inmates who had history of tooth extraction in the past were also about 2.8 times (AOR = 2.83; 95% CI: 1.11- 7.22) at the risk compared to those who had no such experience. Conclusion: This study found that prison inmates had intermediate prevalence of hepatitis B virus infections. Based on the findings of this study sharing of sharp materials and history of tooth extraction are the most important risk factors for acquiring HBV infection in this prison. Thus, improving the individual education and expanding the HBV vaccination coverage may reduce the rate of infection in this subpopulation. Key words: Hepatitis B virus , Prison.
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    Assessment of HIV//Aids risk Behavior Difference Between out of School Anti--Aids Club Members and Non--Club Member Youths,, Jimma and Agaro towns,, South West Ethiopia
    (Addis Abeba Universty, 2003-04) Yazachew, Meseret; Ali, Ahmed (PhD)
    Sexual risk behaviors remained one of the most important tools for assessing the trend of HIV/AIDS epidemic in SSA regions. Further more, they are the major indicators utilized in several evaluative studies for the effectiveness of HIV/AIDS intervention programs, essentially targeting young people. The present study had an objective of assessing the difference in the sexual risk behaviors for HIV infection between out of school anti-AIDS club members and non-member youths in Jimma and Agaro Towns from January to February 2003. Quasi-experimental design in which proportions of major risk behaviors for HIV infection among randomly selected sample of anti-AIDS club member youths of Jimma town compared with a similar sample of non-club member youths in Agaro Town was employed. A pre-tested interviewer administered questionnaire was used to collect data. FGDs were also conducted in the two groups to complement the quantitative findings. The study participants were categorized into four homogenous strata based on their sex and age. Among the study participants, about one third of the club members and a quarter of non-club members admitted to have practiced sexual activity with the mean age at sexual debut of 16.8(61.9) and 16.8(62.1), respectively. Of the sexually active respondents, 30.3% of club members and 16.4% of the non-club members reported to have had two or more non-commercial sexual partners in the last one year, while only 46% and 39.3%, respectively used condom consistently. The differences were not statistically significant in both cases. Club members were found to have better scope of knowledge and attitude and more proportions perceive them themselves to be at risk of VIII HIV infection compared to the non-club members. Both quantitative and qualitative design identified the presence of major misconceptions pertaining to HIV transmission and the role of condom among the non-club member comparison groups. Adolescents and in-school youth were more likely to limit self to a single partner than the older groups. On the other hand alcohol and khat consumption were shown to have a potentiating effect for risky sexual practice. From this study it was concluded that youths organized under anti-AIDS clubs in Jimma town had a better off knowledge, attitude and perception pertaining to HIV/AIDS, while risk practice remained uniform with that of un-intervened group. Thus, more intensified, and comprehensive approach with adequate policy and social support from relevant sectors is highly recommended.
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    Assessment of Insecticide Treated Nets coverage for Malaria Control in Kafta-Humera District, Tigray: Possession vs. Use by high-risk groups
    (Addis Abeba Universty, 2006-06) Haileselassie, Berhane; Ali, Ahmed (PhD)
    Background: In endemic areas, children under five and pregnant women are vulnerable to malaria and are likely to benefit most from the use of nets. Use of insecticide-treated nets (ITNs) for protection against mosquito bite during sleep is highly effective. Kafta-Humera is one of the targeted Districts in the Region for ITNs intervention, but with limited information pertaining to priority of utilization. Objective: to examine the status of children under five years of age and/or pregnant women ITNs possession and utilization and its determinants for malaria control. Methodology: A comparative cross-sectional study was conducted in the rural and urban areas of the District. Based on a systematic random sampling method, 414 households were interviewed each from the selected Kebeles for both settings, regarding net possession and utilization by high-risk groups. Qualitative data were also collected through focus group discussions (FGDs) to identify views of participants, pertaining to ownership and utilization. An early morning survey was also carried out in order to observe the actual behavior of the community towards net use. Result: Net and ITN possession was 84.5% and 80.0% for rural, but 96.1% and 91.1% for urban settings. Net possession was higher among urban (OR 3.33, 95%CI 1.39, 7.98) compared to rural areas. Observed net and ITN use during the preceding night by children under five years of age was 68.6% and 67.0% for rural; and 84.6% and 79.5% for urban areas. Likewise, similar practice for pregnant women was 52.1% and 64.7%, the same for net and ITN in rural and urban areas respectively. Net re-impregnation was 93.5% for rural and 94.1% for urban areas. The FGD suggested that lower net possession in rural areas could be due to scarcity of net provision and inequity while distribution. Occupation, family size in rural areas; radio possession in urban areas and vii relative wealth and number of sleeping places had effect in both settings to own a net. Relative wealth, radio possession, malaria education message in rural and occupation in both settings had a positive effect on net use. Conclusions: Not all nets owned by the households were being utilized properly. Nevertheless, mal distribution, and scarcity were also observed within the settings. Effective IEC should be promoted and continues availability of ITNs should be in place in order to achieve effective control of malaria among the high-risk groups.
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    Assessment of perceived barriers to behavioral change towards the prevention of HIV/AIDS in Bahir Dar Town, northwest Ethiopia
    (Addis Abeba Universty, 2004-06) Sedeta, Befekadu; Ali, Ahmed (PhD)
    Globally, HIV/AIDS has created an enormous challenge to the survival of mankind. It has now become the leading cause of death in many developing countries especially in the Sub-Saharan African countries. Industrialized countries have achieved significant result in the prevention and control of the disease mainly through the behavioral change interventions. Ethiopia is one of the seriously affected countries by the epidemic. The disease is affecting the majority of the population, particularly the productive age group between 15-49 years, resulting in social and economic crisis. Though continuous Information, Education and Communication (IEC) interventions have made efforts in increasing awareness about modes of transmission and prevention of HIV/AIDS, they have not successfully been able to bring about the desired behavioral change among the population. Thus, the main objective of this study was to assess perceived barriers to behavioral change towards the prevention of HIV/AIDS among the urban community of Bahir Dar, where the highest prevalence of HIV infection was already documented. The study design was crosssectional, including both quantitative and qualitative methods. Using multi-stage sampling technique, 910 urban residents aged 15-49 years were selected and interviewed. The study has found out that though the majority of the population had awareness and favorable attitudes towards the prevention of HIV/AIDS, some of them did not show behavioral change towards its prevention. The perceived barriers to the behavioral change were low IEC interventions (31.3%), unemployment (29.5%), increase in illegal video showing and khat houses (28.7%), low involvement of the community in the prevention activities (22.5%), gender inequalities (12.2%), traditional malpractices (10.8%), stigma and discriminations attached to HIV/AIDS (10.1%), inadequate recreational facilities for the youth (8.1%) and low involvement of the religious organizations in the prevention efforts (7.0%). Some of the socio- demographic characteristics, namely, sex, age, marital status, occupation and exposure to mass media were found to influence change of behavior towards the prevention of HIV/AIDS. The majority of the respondents were aware of HIV/AIDS and could answer at least viii one means of transmission and preventions HIV/AIDS, but only 19.6% and 29.1% of the respondents could answer the three major means of transmission and prevention of the disease, respectively, indicating that there is still low level of comprehensive knowledge related to HIV/AIDS among the population. In general, the study indicated that the behavioral change towards the prevention of HIV/AIDS can be affected by some of the socio-demographic variables of the population. Moreover, the perceived barriers towards the prevention of HIV/AIDS among the population were low level of comprehensive knowledge about HIV/AIDS and factors related to communication, cultures, socio-economic status and gender relations. Thus, besides the poverty alleviation programs, community and multisectoral HIV/AIDS relatedinterventions through appropriate and effective IEC strategy are vital in removing the barriers and bringing about sustainable behavioral change towards the prevention of HIV/AIDS among the population.
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    Assessment of Provider–Initiated HIV Testing and Counseling Acceptance and Disclosure of HIV Status and Factors Related to them, among Out Patient Department Patients in the DebreBirhan Referral Hospital, N. Shoa Administrative Zone, Amhara National Regional State
    (Addis Abeba Universty, 2011-03) Hailu, Awraris; Ali, Ahmed (PhD)
    Background HIV counseling and testing is the critical entry-point for engagement into treatment and care as well as for primary and secondary HIV prevention efforts. Despite the importance of this step, most HIV-infected patients globally, and particularly in resource-poor settings, are unaware of their HIV status and the uptake of Voluntary Counseling and Testing (VCT) services is relatively limited. Missed opportunities for addressing HIV testing remain unacceptably high when patients seek medical care in the period before their HIV diagnosis. HIV counseling and testing is increasingly shifting from the client-initiated towards other modalities, especially provider-initiated testing and counselling. Objectives: The objective of this study was to asses the magnitude of PITC acceptance and disclosure and factors related to them among out patient department patents. Methods: A facility based cross sectional quantitative survey was conducted from Dec. 1 to Jan. 10 on 414 clients attending out patient department in Debre Birhan Referral Hospital. Data were collected using structured questionnaire, entered into EPI info version 3.5.1 and analyzed by SPSS version 16. Logistic regression model was used to assess factors associated with PITC acceptance and disclosure of test result. Result: A total of 414 subjects (response rate, 100 %) responded to the questionnaires. Acceptance of PITC among OPD patients was 83.6%. Adjusted correlates of PITC acceptance included female gender (AOR=2.27, 95% CI=1.16-4.42) and knowledge of HIV transmission (AOR=4.08, 95% CI=1.98-9.91). Individuals with protestant religion were less likely to accept PITC (AOR=0.21, 95% CI=0.06-0.72). Key barriers to accept PITC included being apparently healthy (25%), being tested before (22.1%) and fear of stigma and discrimination (19.1%). The vast majority 120 (90.5%) of the married respondents who had ever been tested for HIV disclosed their result to at least one person. Of 346 respondents, who accepted PITC, 288 (83.2%) had a plan to disclose their result to any other person. Compared with the age group 45 and above, subjects 15-24 years old were less likely to disclose their HIV status (AOR=0.16, 95% CI=0.04-0.62). Disclosure of test result was associated with occupation (AOR=5.42, 95% CI=1.44-20.43) and test result negative (AOR=4.00, 95% CI=1.53-10.47). The reasons for non disclosure were fear of stigma 37 (62.7%) followed by fear of blame 8 (13.6%). Conclusion and recommendation: In this study, PITC acceptance was promising and should be expanded to other health facilities. Efforts should be strengthened to decrease factors which impede HIV test result disclosure.
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    Assessment of Socio-Cultural Determinants for the Spread and Prevention Of HIV/Aids in Hamer Woreda, SNNPR
    (Addis Abeba Universty, 2003-04) Altaye, Samuel; Ali, Ahmed (PhD)
    HIV/AIDS is primarily perceived as an urban problem. However, the number of people living with HIV in rural areas is considerable. In rural Ethiopia the current HIV prevalence is reckoned to be 3.7%. The available literature as well suggests that about a quarter of the farmers’ report sexual relation with commercial sex workers in nearby small towns. The present study had an objective of assessing risks contributing to the spread, prevention and control of HIV/AIDS in Hamer Woreda, southern Ethiopia. A cross-sectional study was conducted using a pre-tested interviewer administered questionnaire with supplemental FGD and IDI. About 40% of adults in Hamer were found to spend nights in other locations outside home within the last one month, the commonest reasons for that being marketing trips to urban centers within and the neighboring woredas. Among those who spent nights in town, 45.9% reported having had unprotected sex with local liquor sellers. Other prevailing socio-cultural factors and rituals such as, pre-marital sexual relation ships, multiple sexual practices, extra-marital sexual activity, wife inheritance, “Ivangadi”, mass circumcision seem to contribute to the risky behavioral practices to spread of the HIV virus in the community. The comprehensive knowledge of the community about HIV/AIDS was also relatively lower than the recent BSS for pastoralist communities. ix Thus, more extensive health education program through different out lets with due consideration of the deep-rooted cultural and traditional practices of the community is forwarded. Moreover, involvement of the community in the process of bringing about urgent solutions for the prevailing problems is recommended.
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    Assessment of the Magnitude and Determinants of Hypetension among Outpatient Attedants at Health Centers in Akaki Kality Sub-City, Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2017-05) Tolera, Berhanu; Ali, Ahmed (PhD)
    Background: - Fatalities from hypertension in East Africa are increasing even though it decreased in western industrial regions. Older age, female, illiterate, smoking, physical inactivity and high waist circumferences are major risk factors for the development of hypertension. The prevalence of Hypertension among federal ministry civil servants in Addis Ababa was found to be high; which is an indication for institution based hypertension-screening programs. This study aimed to collect and organize the data about prevalence and associated factors of hypertension. Objective: - To assess the prevalence and major associated factors of hypertension among Outpatient attendants at Health Centers in Akaki Kality Sub-City. Methodology: - Cross-sectional study was conducted on 401 outpatient attendants whose age were greater or equal to 18 years from the four Government Health Centers in Akaki Kality sub-city. Systematic random Sampling was used to select study subjects from each Health Center. The data were collected by face-to-face interview. A structured pre tested questionnaire was used for data collection. The questionnaire was adopted from WHO STEPWISE survey and included additional information. In addition, blood pressure was measured using manual sphygmomanometer and stethoscope, Weight by adult weight scale, Height by tape meter and BMI was calculated. Results: - The overall prevalence of hypertension was found to be 14% (95% CI: 13.653-14.347); of which 30 (53.57%) were males (P- value > 0.05). Based on this data, alcohol drinkers were 11.844 times more likely to be hypertensive compared to non-alcohol drinkers (AOR= 11.844, 95% CI: 3.596-39.014). Cigarette smokers were 16.511 times more likely to be hypertensive compared to non-cigarette smokers (AOR= 16.511, 95% CI: 4.775-57.084). Khat chewers were 6.964 times more likely to be hypertensive compared to non-chat chewers (AOR= 6.964, 95% CI: 1.773-26.889). BMI (AOR=1.320, 95% CI: 1.149-1.516) and age (AOR=1.040, 95% CI: 1.004-1.077) were also significantly associated with hypertension. Conclusion: - The prevalence of hypertension is 14% among OPD attendants in Akaki Kality health centres. Alcohol drinking, cigarette smoking, Khat chewing, BMI ≥ 25 kg/m2 and Age ≥ 44 years old are major determinants identified by this study. Keywords: prevalence, associated factors, hypertension, Ethiopia
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    Assessment of Use of Insecticide Treated Mosquito Nets and Factors Affecting it in Serbo Town
    (Addis Abeba Universty, 2005-04) Getachew, Sofonias; Ali, Ahmed (PhD)
    Background: Among malaria control measures, use of mosquito nets is the one that is getting more acceptance and is being used in large scale worldwide. Despite on going distribution and use of nets in Ethiopia, the household level situation in utilizing them is by and large unknown. Objective: Assess utilization of mosquito nets in Serbo Town and clarify socio demographic, organizational, economical, behavioral and other factors related. Method: Qualitative and quantitative methods were used. In the Quantitative part, interviewer administered questionnaire with a checklist was used for a household. Qualitative section included focus group discussion of community members and in depth interview of important stake holders. Result: Malaria was recognized as a major problem. Children were said to be more effected groups, but did not intentionally get protection. Half of the households possess at least one net. Nets however, were not always used for the intended purpose. Common malpractices were selling, use as curtain and leave the nets in package. Main reasons were economical and unfavorable health belief. Factors that were independently associated with use were: possession of a radio, being knowledgeable, getting health education, number of persons per room and number of beds. Predictors of purchasing were occupation, possession of a radio and being knowledgeable. Discussion, conclusions and recommendations: Reasons for improper use were economical, housing condition, health belief, organizational effort and possibly biological. Selection of control measures, should take into consideration local situation. Once chosen as methods of prevention, mosquito net distribution should have proper guideline and local capacities for doing so should be strengthened. Education messages should focus on the need for prioritizing young children, possible use over sleeping floors and mending holes on nets using local material. Color and design of nets should take into consideration housing condition, and the trend of using for other purposes.
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    Assessment of VCT Utilization, and Willingness to Accept Provider-Initiated HIV Counseling and Testing among Tuberculosis Patients in Addis Ababa
    (Addis Abeba Universty, 2007-04) Maru, Melaku; Ali, Ahmed (PhD)
    Addis Ababa City Administration Health Bureau is recently implementing Provider Initiated HIV Counseling and Testing (PIHCT) in response to the high HIV prevalence among TB patients, and in an attempt to increase the uptake of HIV testing and ART. However, there has not been precise information pertaining to the Voluntary counseling and testing (VCT) utilization status by tuberculosis (TB) patients. This study was conducted in June 2006 to assess VCT utilization rate, perceived barriers for HIV testing, and willingness for PIHCT among TB patients in Addis Ababa. Facility-based, cross-sectional study was conducted and 423 TB patients interviewed. A stratified two stage sampling method was used for the selection of study subjects. In the first stage of sampling, eight health centers were selected by simple random sampling. In the second stage of sampling, patients were systematically selected in each selected health center. The study had used quantitative and qualitative data collection methods. The prevalence of self reported HIV testing among sampled TB patients was 57%. Adjusted correlates of HIV testing include primary education (AOR=2.04, 95% CI=1.03-4.06), being merchant (AOR=5.67, 95% CI=1.56-20.60), had moderate HIV risk perception (AOR=5.30, 95% CI=1.67-16.82), and high-HIV risk perception (AOR=4.38, 95% CI=1.32-14.55). Patients who had willingness for PIHCT found more likely to have been tested for HIV (AOR=2.32, 95% CI=1.23-4.36). While experiences with client and provider-initiated HIV testing overall were positive, 86.2% of the patients were willing for PIHCT. The only adjusted correlates of willingness for PIHCT were being older age group (AOR=4.16; 95% CI= 1.59-10.81), and had demand for HIV testing (AOR=29.13; 95% CI =13.83-61.32). vi Key testing barriers include self trust (41.1%), lack of risk perception for HIV infection (24.4%), fear of learning positive result (13.9%), and stigma and discrimination attached to TB and HIV as identified in focus group discussions. Early evidence of widespread support for PIHCT and moderate acceptance of HIV testing in this study holds significant promise for the control, prevention and treatment of HIV/AIDS and TB. Concerted efforts to scale up PIHCT, however, must be accompanied by intensive IEC on TB /HIV along with tackling of testing barriers.
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    Determinants of use of skilled birth attendance among mothers who gave birth in the past 12 months in Raya Alamata District: community based Comparative cross sectional study
    (Addis Abeba Universty, 2013-06) Tadese, Fentaw; Ali, Ahmed (PhD)
    Background: A large number of women are dying due to factors related to pregnancy and childbirth, especially in developing countries including Ethiopia, where maternal mortality ratio is one of the highest in the world. It is known that having a skilled birth attendant at every delivery can lead to marked reductions in maternal mortality. In Ethiopia, most births take place at home, particularly in rural areas, being not attended by a skilled birth attendant. The utilization of maternal health services is a complex phenomenon and it is influenced by several factors. Objectives: This study assessed factors that determine the utilization of skilled birth attendants among mothers who gave birth in the past 12 months in Raya Alamata District, Tigray Region, Ethiopia. Methods: Community-based comparative cross sectional study was conducted among mothers who gave birth in the past 12 months. Mixed methods of study combining both quantitative and qualitative research were used. A total of 580 study participants were recruited for the study. The investigator prepared pre-tested and structured questionnaire to collect data. Logistic regression was performed using SPSS version 16.0 software and thematic interpretation based on main categories was done for the qualitative data. Results: A total of 567 mothers (172 urban and 395 rural) were included in the analysis. Only 23.1% of births were attended by SBAs. Over 44% of urban women delivered with skilled assistance compared to 13.9% of rural women. In multivariate analysis urban residence (AOR = 2.2, 95%CI: 1.2, 4.0), maternal formal education (AOR=5.2, 95%CI: 3.0-8.8), ANC visit during the last pregnancy (AOR = 3.8, 95%CI: 2.0-7.3), joint final decision making (AOR=3.3, 95%CI: 1.9-6.1), knowledgeable (AOR=2.95, 95%CI: 1.7-5.1) and favourable attitude towards danger signs of pregnancy, child birth and delivery services (AOR=2.6, 95%CI: 1.3-5.1) were most significant determinants of SBA use by mother. Age at interview 15-24 and 25-34 had also a significant effect on skilled birth attendant utilization with (AOR=4.8, 95%CI: 2.0-11.6) and (AOR=3.8, (95%CI: 1.7-8.6) respectively. Conclusion and recommendation: Utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified persons at home. Promotion of universal ANC follow-up and encouragement of mothers regarding the need for SBAs during childbirth is of paramount importance. Increase the awareness of mothers and their partners about the benefits of institutional delivery and SBAs and use of different means of behavioral change communication is very fundamental.
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    Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2017-06) Demissie, Getachew; Ali, Ahmed (PhD)
    Background: Influenza is a highly infectious viral illness. The name ―influenza‖ originated in 15th century in Italy, from an epidemic attributed to ―influence of the stars.‖ Influenza is a single-stranded, helically shaped, Ribonuclic Acid virus of the orthomyxovirus family. Basic antigen types A, B, and the nuclear material determines C. In January 2011, Center for Disease Control estimated that pandemic H1N1 influenza virus caused more than 60 million Americans to become ill, and led to more than 270,000 hospitalizations and 12,500 deaths. Influenza A viruses in Ethiopia were reported nine confirmed cases and one pending as of August 2009. On 24 February 2016, a suspected H1N1 influenza like illness outbreak reported from Robe Woreda, Arsi Zone, to Oromia Regional Health Bureau Public Health Emergency Management team. Investigation was made to confirm the outbreak, identify risk factors and implement control measures. Methods: Unmatched case-control study conducted. Structured questioner used to collect data from 16 cases and 32 controls. Controls defined as any person in the prison without sign and symptom of the disease. Sixteen blood specimens collected for laboratory confirmation. Results: Sixteen suspected H1N1 cases identified and no death documented. Five of sixteen swab specimens tested positive for influenza sub type A H1N1pdm09. The overall attack rate was 31.25%. Conclusion: A confirmed influenza sub type A H1N1pdm09 outbreak occurred in the prison of Robe woreda, Arsi Zone, Oromia Region. The outbreak affected prisoners, and workers of the prison. Active surveillance should be strengthened by the Woreda Health Office for the disease to reduce the risk of future outbreak in the prison. Key words: H1N1, Outbreak, Prison, Ethiopia
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    Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2015-05) Bahiru, Getahun; Ali, Ahmed (PhD)
    Background: Measles is one of the most communicable infectious diseases with greater than 90% attack rate on susceptible persons. Although efforts have been made to improve vaccination coverage, there have been encounters of outbreaks here and there in Ethiopia. On September 8, 2014 unknown cause of respiratory disease outbreak was reported from Kbebe-Tsehay Orphanage, Addis Ababa the Capital City of Ethiopia. We investigated to confirm the outbreak, identify risk factors and implement control measures. Methods: Both descriptive and unmatched case-control study, using two controls was `conducted in Kbebe-Tsehay Orphanage. Patient observation was made at Health-Care Facilities. Suspected Cases were defined as: Children with fever and cough and with or without diarrhea, vomiting, respiratory distress and coryza. Controls were defined as any children living in Kbebe-Tsehay orphanage without sign and symptom of the disease. A suspected case with laboratory confirmation (positive IgM antibody) or epidemiological link to confirmed cases in an epidemic. We reviewed Hospital records where patients were admitted (Girum, Betsega, St.Yared, Yekatit12 Hospitals and Kbebe-Tsehay Orphanage Clinic) and line list was also prepared to gather information about new cases which was maintained until the end of the outbreak. We interviewed cases and controls using a questionnaire through their Guardian and the camp nurses. Five blood samples were collected for laboratory confirmation. We used Epi Info version 7.3.1 and micro- soft excel for data entry and analysis. Results: Three of five blood samples tested positive for measles IgM antibodies. A total of 22 measles cases with one death were reported starting August 25, 2014 to September 10, 2014. The overall attack rate (AR) and Case Fatality Rate (CFR) were 14.7/100 population and 4.5% respectively. From all cases (22), none developed clinical sign of rash. Among all, the total numbers of measles cases were higher in females 13 (59.1 %) than males 9 (40.9 %). The median age of cases was 7 months and controls 48 month. Only 9 (40.9%) of the cases were vaccinated and 13 (59.1%) were not vaccinated, whereas 9 (20.5%) of the controls had recorded measles 3 vaccination history and 35 (79.5%) had no vaccination cards. From the study groups 22 (100%) cases and 9 (20.5%) controls had contact history to a suspected case. Sharing a bed with two or more children (OR: 8.11; 95% CI: 2.5 – 26.6) and the new children admitted to the dorms (OR: 13.2; 95% CI: 3.8 – 45.6) were found to be significantly associated with the disease. Conclusion: A measles outbreak without rash was confirmed with one death (CFR 4.5%). Sharing a bed with more than one child and being a new child in the orphanage were noted to be significant risk factors for developing the disease. Therefore, using a separate bed and knowing the vaccination status of new children admitted into the orphanage are recommended as mechanisms to limit transmission of measles epidemic. Key Words: Measles: Outbreak: Case Control: Kbebe-Tsehay Orphanage.