Browsing by Author "Ali, Ahmed (Professor)"

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    Does Distributing Pamphlet Make a Difference in Knowledge and Attitude towards VCT among High School Students?
    (Addis Ababa University, 2007-01) Kebebew, Tolcha; Ali, Ahmed (Professor)
    In order to attain change in knowledge, attitude and behaviour, the community should have access to adequate and factual health information. In Ethiopia, most of the health institutions develop one or more of printed health education materials, majority of which are pamphlets and posters on HIV/AIDS. Although such materials are being distributed, the level of their effectiveness in changing knowledge, attitude and behaviour of the target population is not established in the local context. The objective of this thesis research was to develop and test the effectiveness of a VCT pamphlet in changing knowledge and attitude of high school students towards VCT in North Shoa Zone, Oromia Region, Ethiopia. A Randomized Controlled Trial was conducted to test the effectiveness of a VCT pamphlet in changing knowledge and attitude of high school students towards VCT. The intervention and control groups were selected randomly from the two high schools found in North Shoa. Single blinding was employed to avoid the Hawthorn effect. The VCT pamphlet was given only to the intervention group. The pre-and post-intervention knowledge and attitude of students towards VCT were assessed by the use of structured and pre-tested self-administered questionnaire. The distribution of change in knowledge and attitude were computed. There was a significant difference in change in knowledge between intervention and control groups (t = -9.12, df = 720, p< 0.01), i.e. it was significantly high among the intervention group. On the other hand, change in attitude was not significantly different among intervention and control groups, even though there was an increase in attitude towards VCT. The change in knowledge was significantly associated with some sociodemographic, sexual partner number, stigma and discriminatory attitude, and baseline knowledge and attitude towards PLWHA (p< 0.05). The study shows that it is possible to change the knowledge of the target group through distributing pamphlets, and perhaps not the attitude. It is recommended to consider different factors such as socio-demographic, knowledge and attitude level of the audience before preparation and distribution of pamphlets to attain the intended change
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    Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2015-06) Emiru, Yirdaw; Ali, Ahmed (Professor); Bezabih, Belay
    The Ethiopia Field Epidemiology Training Program (EFETP) is a two years competency based masters program adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) Program. The School of Public Health/Addis Ababa University, the Federal Ministry of Health of Ethiopia/Ethiopian Public Health Institute (EPHI), the Ethiopian Public Health Association (EPHA), and CDC Ethiopia are running the Program jointly. The field work comprises of 75% of the Program which is called residency; learning by working in public health emergency and other health related priority issues. The Program is designed to assist the Ministry of Health in building or strengthening health systems by recruiting promising health workers and building their competencies through on-the-job mentorship and training. Ethiopia adopted the Field Epidemiology Training Program to help improve leadership within Public Health Emergency Management. The Ethiopian Field Epidemiology Training Program (EFETP) provides residents a Master of Public Health Degree in Field Epidemiology after they complete two years of supervised work in applied or Field Epidemiology. This compiled body of works has nine main sections or chapters accomplished during the residency time of the Program. The first eight sections are expected outputs during the residency time; comprising of outbreak investigation, surveillance data analysis, evaluation of the surveillance system, health profile description report, writing of finalized scientific manuscript for peer review journals, abstracts submitted to scientific conferences, writing protocol/proposal of epidemiologic research project, summary of disaster situation visited/risk assessment and other additional works. EFETP Yirdaw Emiru yirdaw_emiru@yahoo.com Page xiii The overall outputs of the two years Field Residency Program are presented in a summarized way; in the outbreak investigations chapter or section, two outbreaks were investigated and documented. Those included measles outbreak in Bure Zuria District, West Gojjam Zone, Amhara Region, April 2015 and unmatched case control outbreak investigation of relapsing fever in Debre Markos Town, Amhara Region, Ethiopia, December 2014. Health profile description report was done in Bure Zuria District in March 2014 and Surveillance system evaluation was also done in Bure Town & Bure Zuria Districts, Amhara Region, in July 2014. One finalized scientific manuscript was prepared for peer reviewed journal. Two abstracts were also prepared for scientific conferences. A report on need assessment (risk assessment) on prioritized Districts of Amhara Regional State was also conducted with other team members from food security center, WHO, UNICEF and EPHI. Under other additional works/outputs section (last chapter) activities like provision of training for public health emergency management (PHEM) officers working at different levels (regional to health facility level) in the Amhara Regional Health Bureau were also undertaken
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    Spatial variations and associated factors of food insecurity and child under nutrition in east Gojjam zone, Ethiopia: a multilevel mixed effects model.
    (Addis Ababa Universty, 2018-10) Aderaw, Zewdie (PhD); Ali, Ahmed (Professor)
    Background: - Child undernutrition remains a major public health challenge. The magnitude of the problem varies based on geographical location. In Ethiopia, spatial analysis studies were done based on coarse spatial resolutions. To be more efficient in targeting interventions geographically, spatial analysis using micro level spatial resolution is recommended. Accordingly, different studies were done to identify factors associated with food insecurity and child undernutrition, but most of them ignore either the individual or community level factors. Hence, identification of spatial variations and individual and contextual level determinant factors of food insecurity and child undernutrition in XVI | P a g e relation to the agroecosystem is essential to deliver targeted, efficient and sustainable solutions to the problems. Objectives: - This study determined spatial variations of food insecurity and child undernutrition. The study also identified the role of individual and community level factors of food insecurity and child undernutrition using multilevel mixed effects regression analysis in East Gojjam Zone, Ethiopia. Methods: - An agroecosystem linked to community based comparative cross sectional survey was conducted among 3108 households with children aged 6-59 months. Multistage cluster random sampling technique was used to select study participants. Data were collected on household geographical location, socio-demographic characteristics, child and maternal anthropometry and on potential individual and community level determinant factors. Collected data were entered using Epi info version 3.5 and exported to World Health Organization (WHO) Anthro to determine child nutritional status. SaTScan software was used to determine spatial variations of food insecurity and child undernutrition using SaTScan Bernoulli model. To identify the most likely clusters using SaTScan software, the Log Likelihood Ratio (LLR) at 95% Confidence Interval (CI) and P value less than 0.05 as the level of significance were considered. To identify determinant factors of food insecurity and child undernutrition, multilevel mixed effects ordinal regression and multilevel mixed effects linear regression analyses were used, respectively. The results of fixed effects were shown as an adjusted odd ratio (AORs) for the multilevel mixed effects ordinal regression and regression coefficients for the multilevel mixed effects linear regression. The results of random effects were presented as variance and the intra-class correlation coefficient (ICC) was calculated to estimate unexplained variance attributable to cluster level. Results: - The overall prevalence of household food insecurity was 65.3% (95% CI: 63.5, 67.00). The highest prevalence of food insecurity was observed from the lowlands of the Abay Valley (70.6%, 95% CI: 66.9, 74.2). Followed by the hilly and mountainous highland areas of Choke Mountain (69.8%, 95% CI: 65.9, 73.3). Similarly, sample clusters taken from hilly and mountainous highland areas (LLR: 11.64; P<0.01) and low lands of the Abay Valley (LLR: 8.23; P<0.05) were identified as the most likely primary and secondary clusters, respectively. XVII | P a g e The prevalence of stunting 39.0% (95% CI: 37.32, 40.75), 18.7% (95% CI: 17.32, 20.0) underweight, and 12.22% (95% CI: 11.12, 13.42) wasting were observed in the study area. The highest prevalence of wasting (15.9%; 95% CI: 13.5, 18.8) was observed from hilly and mountainous highlands. The highest prevalence of child stunting (42.4%; 95% CI: 38.5, 46. 6) and underweight (22.9%; 95% CI: 19.7, 26.3)) were observed from the lowlands of Abay Valley. SaTScan spatial analysis indicated that sample clusters taken from the hilly and mountainous highlands were the most likely primary cluster for child wasting (LLR: 13.0, p < 0.01) and underweight (LLR: 23.16, p < 0.001). Also, primary cluster for child stunting was identified from lowlands of Abay Valley (LLR: 10.78, p<0.05). After adjusting for both individual and community level determinant factors, 1.5% (p<0.001) of the variance of food insecurity was attributable to the cluster level. Similarly, after adjusting for all potential determinant factors, 2.4% (p<0.001) of the child weight for height Z score and 1.4% (p<0.001) of the child height for age Z score variance were due to cluster level. From level one factors, in the final model, household head being male, marital status being in union, higher parental education, women’s participation in household decision making, having additional income sources, better crop production in the survey year and application of chemical fertilizer have a positive influence in mitigating household food insecurity. From community level determinant factors, households being from hilly and mountainous highlands and lowlands of the Abay Valley were more severely household food insecure compared to midland plain areas. Households with better farmland size showed less severe household food insecurity in the study area. In the study, from level one factors, the number of under five children, antenatal (ANC) follow up, breast feeding initiation time, household dietary diversity, mother nutritional status, household food insecurity and diarrheal morbidity were associated with weight for height Z score. From level two factors, agroecosystem characteristics, proper household refuse disposal practice, agroecosystem characteristics and proper latrine utilization were significantly associated with child weight for height Z score. From level one factors, child age in months, child gender, the number of under-five children in the household, child immunization status, breastfeeding initiation time, mother nutritional status, child diarrheal morbidity, household level water treatment practice and household dietary diversity showed a statistical significant association with child height for age Z score. From level two factors, agroecosystem characteristics, proper household refuse disposal practice and proper latrine utilization were significantly associated with child height-for-age Z score. XVIII | P a g e Conclusions: - The prevalence of food insecurity and child undernutrition were public health concerns in the study area. Spatial variations of household food insecurity and child undernutrition were observed across the agroecosystems. Households from the lowlands of Abay Valley and hilly and mountainous highland areas were more vulnerable to food insecurity and child undernutrition compared to midland areas. The SaTScan cluster level spatial analysis identified statistical significant hotspot clusters for food insecurity, childhood stunting, underweight and wasting. The multilevel mixed effects analysis indicated that the heterogeneity of food insecurity, childhood stunting and wasting were observed after adjusting to potential individual and community level determinant factors. Both individual and community level factors played a significant role in determining food insecurity and child undernutrition (stunting and wasting). An agroecosystem characteristic was one of the community level factors affecting household food insecurity and child undernutrition. Recommendations: - The spatial variation of food insecurity and child undernutrition based on agroecosystem characteristics should be fully understood by program implementers and policy makers during planning, resource allocation and community mobilization in the study area. Water, sanitation and hygiene interventions are important in the study area. Further study on spatiotemporal variations of food insecurity and child undernutrition at different time is recommended. Also, food insecurity and child undernutrition intervention strategies and plans designed using aggregated or macro level evidence may not indicate the true picture of spatial distribution of the problem at lower government administrative units. So, program level planning may take into account agroecosystem based micro level variations to allocate resources. Policy and intervention strategies aiming at mitigating food insecurity and child undernutrition should address the effects of lower and community level determinant factors using the integration of individual/household level and geographical targeting.
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    Willingness of Pregnant Women Attending Antenatal Care towards Voluntary Counseling and Testing
    (Addis Ababa University, 2006-06) Ambaye, Yemane; Ali, Ahmed (Professor)
    Voluntary HIV counseling and testing (VCT) is one of the priority interventions in HIV/AIDS prevention, care and support. VCT is an entry point for the prevention of HIV transmission from mother to child and accessing VCT benefit from PMTCT services. This study was designed, to assess the magnitude and identify factors associated with pregnant women’s expressed willingness towards VCT and describe their knowledge. Cross-sectional institution based interview survey of 421 pregnant women was held in one district hospital, two health centers and three health stations. The study was complimented with four FGD and Key-informant interviews. The study was done in Wukro & Kleteawlaelo Woredas of Tigray Regional State, north Ethiopia. The expressed willingness of study participants for VCT was found to be 74.1%. On examination of multiple factors to detect whether there is association with willingness to VCT or not: being multigravida (AOR=7.1, 95%CI=1.05,48.3),intention to discuss HIV positive result with partner(AOR=7.01, 95% CI=1.74,28.15), believing partner has a greater role for VCT(AOR=3.84, 95%CI=1.12,13.23)were found to have an association .The level of awareness on VCT and PMTCT was 80.3 and 88.5% respectively. This study revealed high-level of awareness about HIV, with as well marked misconception. Expressed willingness was lower when compared to other studies and it was influenced mainly by gravidity of the woman and male partners. Male partner involvement and coordinated IEC can assist to overcome barriers of willingness to VCT. This study could contribute for VCT and PMTCT program expansion in the study area and elsewhere with similar characteristics