Browsing by Author "Tarekegn, Mihretu"

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    Adherence to Option B+ and Associated factors among Pregnant women on Pmtct Services at Public Health facilities of East Shawa Zone, Oromia, Ethiopia
    (Addis Abeba Universty, 2017-05) Tarekegn, Mihretu; Seme, Asefa (PhD)
    Background: Anti-retroviral therapy has made a significant reduction in morbidity and mortality related to HIV/AIDS. However, it cannot be fully realized without addressing barriers related to retention in care and medication adherence. The roll out of simplified Option B+ was launched in Ethiopia in 2013 with the aim of eliminating new HIV infection in children in 2015 and to keep the mother alive. Objective: To assess levels of option B+ adherence and associated factors among pregnant women on PMTCT follow-up at public health facilities of the East Shawa zone, Ethiopia Methods and materials: The study was conducted in public hospitals and health centers in East Shawa zone from January to June 2017. A descriptive cross-sectional study design was implemented to select 304 pregnant women using a systematic random sampling method. Data were collected using a structured and pre-tested questionnaire; the collected data were cleaned and entered into SPSS Version 21 for analysis. Multivariate logistic regression was used to determine association between independent and dependent variables. Result: Two hundred ninety-three pregnant women who were on option B+ participated in the study. The mean ages and standard deviation of the participants were 29.2 ± 4.6. The overall ART adherence of pregnant women on ART medications was 82.6%. The study showed that participants educational status, AOR 4.54(95% CI; 1.72-11.95), participants status disclosure 2.61(95% CI; 1.01-6.71), social and financial support to the participants AOR 2.76(95% CI; 1.17-6.51), counseling on the benefit AOR 2.9(95% CI; 1.27-6.63), were all positively and significantly associated with adherence to option B+ treatment while experience of drug side effect AOR 0.24(95% CI; 0.1-0.6), and fear of stigma and discrimination AOR 15.79(95% CI; 4.64-53.67), were negatively associated with adherence to option B+ treatment. Conclusion and recommendation: While education, counseling on health benefit of treatment for the fetus and the mothers, social and financial support favors adherence, Fear of stigma and discrimination and drug side effects effect negatively affect adherences to option B+ among pregnant women attending PMTCT in public health facilities. The investigator recommends collaborative work among patients, healthcare professionals, and public to enhance ART adherences Key word: HIV, ART, Option B+, Adherence, pregnant women, Ethiopia
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    Species Composition Distribution and Ecology of Anopheles Mosquitoes in Relation to Malaria Transmission and Control in Dembiya District Northwestern Ethiopia
    (Addis Ababa University, 2022-05-04) Tarekegn, Mihretu; Dugassa, Sisay (PhD)
    Malaria is an important vector borne disease transmitted by the infective bite of female Anopheles mosquitoes in malaria endemic areas in Ethiopia. Malaria vector control requires field and clinical data on malaria transmission and ecology of local vectors. A six-year retrospective malaria data set from health facilities was analyzed to determine trends in malaria prevalence in the two malaria-prone areas of Dembiya District, Northwestern Ethiopia. A cross-sectional parasitological study was conducted to determine the prevalence of malaria during the peak transmission season in the two Kebeles of Dembiya district. A longitudinal entomological study on the species composition and ecology of adult and immature Anopheles mosquitoes was conducted from June 2018 to May 2019. Larvae and pupae of Anopheles mosquitoeswere collected from different mosquito breeding habitats using a 350 ml standard dipper, and physicochemical characteristics of the larval breeding habitats were measured in conjunction with larval sampling. CDC light traps, pyrethrum spray catches (PSCs) and artificial pit shelters were used to collect host seeking and resting Anopheles mosquitoes from indoors and outdoors. Using morphological keys, collected Anopheles mosquitoes were identified to the species level and An. gambiae s.l (sensu lato) were further identified to sibling species using polymerase chain reaction (PCR). Enzyme-linked immunosorbent assay (ELISA) was used to examine the blood meal source of blood fed Anopheles mosquitoes, and to detect Plasmodium species using circum-sporozoite proteins (CSP). A WHO test tube bioassay was used to assess the susceptibility status of Anopheles arabiensis to four insecticides such as pyrethroids, deltamethrin, bendiocarb and fenitrothion. Malaria is endemic in the area according to retrospective malaria data from health facilities. Over the past six-years, the overall prevalence of malaria cases was 22.4% (484/2157). Plasmodium falciparum was responsible for 75.1 % (367/484) of the malaria cases in the study area, while P. vivax was responsible for 18.2% (88/484) the malaria cases. The remaining 5.9% (29/484) were mixed infections. Malaria parasites were found in 3.5% (26) of 735 blood smears stained with 3% geimsa and microscopically examined slides. Plasmodium falciparum and P. vivax were responsible for 65% (17) and 19% (5/26) of the malaria infection, respectively, with 15% (4/26) being mixed infections. Males (18/382; 4.7%) were 2.6 times more likely to be infected with malaria than females (8/353; 2.3%) (AOR = 2.6; 95% CI: 1.041- 6.412; p= 0.041). A total of 1,629 Anopheles larvae and 185 pupae were collected from different breeding habitats. Eight species of Anopheles mosquitoes were identified from female mosquitoes that emerged from field collected larvae and pupae, including Anopheles arabiensis, An. pharoensis, An. coustani, An. christyi, An. squamosus, An. demeilloni, An. danicalicus and An. cinereus. Anopheles arabiensis (59.2%) was the most common followed by An. pharoensis (35.3%). Anopheles mosquitoes belonging to 11 species were identified from 2,055 field collected adult specimens during this study: An. pharoensis, An. arabiensis, An. coustani, An. demeilloni, An. cinereus, An. funestus, An. ardensis, and An. squamosus were identified from both Guramba Bata and Arebiya study sites, whereas An. garnhami, An. christyi and An. nili were identified only from Guramba Bata. Anopheles pharoensis was the dominant species identified in both Arebiya and Guramba Bata study sites, accounting for 46.4% (953/2,055), while An. Arabiensis was also relatively dominant in both study sites (38.3%; 776/2055). Anopheles larvae were more abundant in drainage canals (14.7 ± 3.5 larvae/dip) than in other types of breeding habitats such as river side pools (2.0 ± 0.9), hoof prints (3.0 ± 1.2), swamps (3.8 ± 1.2), and puddles (2.7 ± 2.7) (F8,99 = 9.85; p<0.001). The presence or absence of Anopheles larvae was associated with physical characteristics of larval breeding habitats such as turbidity (mid turbid) (AOR = 66.03; 95% CI: 2.01-2168.24, p= 0.019) and presence of grass (AOR= 12.62; 95% CI: 1.29-122.78, p= 0.029). The mean outdoor density of Anopheles mosquitoes collected with a CDC light trap (4.8 ± 1.8 mosquitoes/trap/night) was slightly higher than mean indoor density of Anopheles mosquitoes (4.3 ± 1.7 mosquitoes/trap/night) in Arebiya study site. Similarly, in Guramba Bata, the mean density of outdoor Anopheles mosquito collected with CDC light trap (8.1 ± 2.6 mosquitoes/trap/night) was higher than indoor Anopheles mosquito density (5.5 ± 1.7 mosquitoes/trap/night). The human blood indices (HBI) of indoor and outdoor hosts seeking An. arabiensis were 17.4% and 15.3%, respectively. The overall sporozoite rate of An. arabiensis, An. pharoensis and An. coustani was 0.3%, 0.9% and 5.9%, respectively. Whereas, the annual Entomological inoculation rate (EIR) of outdoor hosts seeking An. arabiensiswas 4.7 infective bites/person/year. Anopheles arabiensis was resistant to deltamethrin and permethrin. In conclusion, the dominant Anopheles vector species in the study area were An. arabiensis and An. pharoensis.The season, and type and physicochemical characteristics of the breeding habitats, influenced the distribution of Anopheles mosquitoes. Anopheles arabiensis, An. pharoensis and An. coustani showed relatively strong exophilic, exophagic and zoophilic tendencies in the study area, which was likely influenced by decades of indoor malaria interventions with IRS and ITNs. Anopheles arabiensis has developed resistance to pyrethroids and deltamethrin that have been used over the years. As a result, malaria control and elimination programmes should target outdoor biting and resting Anopheles mosquitoes with appropriate resistance management measures.