Browsing by Author "Tesfaye, Fikru(PhD)"

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    Assessment of Health Care Seeking Behavior at Household Level in Sodo Zuria Wereda, SNNPR, Southern Ethiopia
    (Addis Abeba Universty, 2005-06) Aweke, Arega; Tesfaye, Fikru(PhD)
    Background: The processes involved in making decision to seek medical care are not fully understood, and many researchers claim that availability and accessibility of health services are the main factors affecting health care seeking behavior of individuals. Objectives: To assess the health seeking behavior of household members, identify the role of local healers in health care service provision, and describe the process of decision making to seek health care. Methods: A community- based, cross- sectional study, was conducted in January 2005 using quantitative and qualitative dada collection methods. The study was carried out in Sodo Zuria Wereda, of Wolaita Zone in Southern Nations and nationalities people region(SNNPR), south Ethiopia. Stratified random sampling technique was employed to select households from rural and urban area. Key informants were selected for in-depth interview using the ‘snow ball’ technique for the qualitative part of the study. The quantitative part used structured and pretested questionnaires to collect data by interviewing the head of households. Households were inquired about illness with regard to the members of the households in the preceding four weeks, for utilization of health care services and perception about local healers. Result: A total of 844 households were visited, of which 233 (27.6 %) were from urban and 611 (72.4%) were from rural areas. Perceived report of symptoms and utilization of health service to illness was conducted in a sample of 824 households consisting of 5114 household members. The prevalence of illness was 9.7% during a recall period of four weeks preceding the interview. Sickness was associated with a family size above six. About 80.1% of those who reported illness viii had visited modern health care services. Of these 49.4% visited private health care providers and 48.6% visited public health facilities. Among sick individuals 47% sought health care within 1-3 days. Of the sick individuals 22.3% got injection, most of which was provided by health centers (35.6%) and clinics (32.7%). About 20% of the sick individuals did not visit any health services, mainly due to shortage of money. There is low level of visit to traditional healers by sick individuals. 44.6% of doctors and 24.7% of nurses provided health care for sick individuals who visited the health care services. Conclusion: There is a favorable health seeking behavior in the study area, with the majority of sick individuals visiting modern health care providers within a few days of illness. There is high number of injection provision at lower level of health care unit. Recommendation: design the family consultation system ought to be employed as health promotion and preventive actions, develop a system of health care provision for those who are not able to get health care, the existing private health care unit utilization should be promoted with due consideration of quality control system, and further exploration is needed for excess injection provision in lower level of health institutions. Key words: illness, sickness, traditional medicine, household, Kebele.
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    Assessment of Knowledge, Attitude, & Practice among Mothers about VCT and Feeding of Infants Born to HIV Positive Women in Jimma Town, Ethiopia
    (Addis Abeba Universty, 2005-06) Hailu, Chernet; Tesfaye, Fikru(PhD)
    Background: In Ethiopia, 96 000 children under fifteen live with HIV, which is related to the prevalence rate of HIV/AIDS and mother to child transmission (MTCT) of the virus.Without intervention, the risk of MTCT of HIV is 15-30% in non breastfeeding populations; breastfeeding by an infected mother increases the risk by 5-20% to a total of 20-45%. Studies have also shown the variation in MTCT rates by duration of breastfeeding, exclusivity of breastfeeding, and the danger of mixed feeding. Objectives: This study was aimed at describing the levels and identifying determinants of knowledge, attitude, and practice (KAP) of mothers about VCT and feeding of infants born to HIV positive women. Methods: A cross-sectional descriptive study was conducted using quantitative method on 876 mothers (231 pregnant and 645 lactating) residing in Jimma town in December 2004 to January 2005, and in-depth interviews on 12 health workers working in VCT/PMTCT service providing health institutions of the town. Results: Among the mothers (n=876), 38.8% had sufficient knowledge about MTCT (during pregnancy, labor, breastfeeding), 41.8% had sufficient knowledge about PMTCT, 30.5% had sufficient knowledge about infant feeding options recommended to HIV positive women, 62.4% had favorable attitude to wards VCT, 4.7% had favorable attitude towards the feeding options, 84.5% visited health institutions for antenatal care and 35.7% used VCT service during their last pregnancy. The lactating mothers (n=643) practiced mixed feeding 81%, exclusive breastfeeding 13.4% and exclusive replacement feeding 0.4%, and most (90.9%) of the pregnant mothers intended to mixed feed their infants of age 0-6 months. Based on logistic regression analysis, knowledge of the mothers about the infant feeding options was significantly associated with their address, age, husbands being important persons for mothers viii to decide on how to feed their infants, and counseling mothers on infant feeding during ANC. Mothers’ attitude towards the feeding options significantly associated with their address. Infant feeding practices of lactating mothers was also having a statistically significant association with their ANC use, place of delivery, and address. Most of the health workers (in-depth interview participants) provided directive advice about the infant feeding optios, and most didn’t include the options heat treated expressed breast milk and HIV negative wet nurse. The participants mentioned mainly failure to afford formula milk, fear of stigma/discrimination, and partners not involved in HIV test as reasons for non adherence of HIV positive mothers to exclusive replacement feeding; while the mothers’ sickness to exclusive breast feeding. In turn, the mothers shifted to mixed feeding. Conclusion: Mixed feeding increases the risk of non HIV diseases like diarrhea and malnutrition for infants of age 0-6 months, and for most of mothers didn’t know their HIV status potentially increases risk of MTCT of HIV. Therefore, strengthening counseling mothers on safe infant feeding practices, and introducing an appropriately designed BCC program to the community on safe infant feeding practices and importance of partners’ involvement in HIV testing and other recommendations are forwarded. Key words: - Infant feeding, VCT, PMTCT, MTCT.
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    Assessment of Safety of Injection and Related Medical Practices in Health Institutions at Sidama Zone, SNNPRS
    (Addis Ababa University, 2004-04) W/Gebriel, Yoseph; Tesfaye, Fikru(PhD)
    Background: There is substantial discrepancy between much of the epidemiological evidence and the belief that nearly all of the HIV burden in sub-Sahara Africa can be accounted by heterosexual transmission and the sexual behavior of Africans. For this a number of observations raise the question of an alternative route of transmission, for which medical care and the use of injections are prime candidates. Objective: To assess the potential risk of transmission of blood born pathogens (HIV, HBV, and HCV) through needles and sharps in health care settings found at Sidama zone of SNNPRS. Methods: Health institutions based cross sectional survey was conducted from November 2003 to March 2004. From 22 government, 9 NGO and 9 private health institutions, 213 health care workers and 352 clients/patients were interviewed; 178 injection practices were observed; and dressing and delivery practices were observed in 37 and 27 health institutions respectively. Result: Accordingly, 74% of the observed injections were found out to be unsafe to the health workers, recipients or to the community. Contaminated and unsterile medical equipment that contact open skin or used for percutanous procedure were observed put ready for reuse in most health institutions. Most (97%) of the health institutes lack at least one equipment that was used for wound care or to assist delivery. Although, most the health care workers were aware of the transmission of diseases through contaminated vi needles, only 7% of them cited HBV, HCV, and HIV simultaneously. Thirty two percent of the health care workers reported a 12-month prevalence of accidental needle or sharp injury. 64% of these were deep or penetrating injuries. Most clients/patients (89.5%) were knowledgeable on the transmission of diseases through dirty needles. One hundred fifty seven (44.6%) of clients responded that they prefer oral drugs to injection preparations, which was preferred by 136(38.6%), when their children have fever. As opposed to the clients/patients, the majority (64.9%) of the HCWs claim that clients prefer injections when they appear to the out patient departments. Conclusion and recommendations: The study revealed that many injection and related medical practices were poor exposing clients/patients, health care workers and the community at risk for blood born pathogens. On job training for health care workers, and assessing reasons for the poor safety using assessment tool “A” was recommended. Key words Unsafe, Injection, medical, practice, health institution, blood born pathogens, health worker, clients, patients, clients
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    Assessment of the Effect of Nutritional Status and Intestinal Parasitic Infection on Academic Performance of Elementary School Children in Teda Town, Gonder, EthioPia
    (Addis Abeba Universty, 2000-12) Abebe, Belete; Tesfaye, Fikru(PhD)
    A cross sectional study was conducted in vo lving 641 students oC the two primary schools of Teda town. North Gonder. The purpose of the study was to determine the nutritional and intestinal parasitic in fection (!PI) status of the chi ldren, the effect of IPI and nutritional status on the children's academic performance, and the effect of I PIon nutrition. Data were collected using questionnai re and anthropometric measurements. Physical and stool examinations were also carried out. Schoo l average scores were obtainedfi'OITI school records. The data were entered. processed and analysed using EPr In fo version 6, computer software (and its subprogram EPINUT). Underweight and stunting were fou nd to be 59.8% and 41.7% respective ly, whereas the overalllPI rate was 77.7%. The commonest infection was Ascaris lumbricoides with prevalence of66.7%, followed by Entameba histolytica with prevalence of 14.8%. Low than high pupils' school average score was significantly associated with underweight, X2 = 39.45, (p value < 0.000 1), and with stunting, X = 19.79, (p < 0.00 1). Intestinal parasitic infection did not show any association with the nutritional status and school performance of the children. A higher proportion of the yo unger than the older age group was underweight, OR = 1.86 (95% CI = 1.32,2.64). Also higher proportion of the urban students than that of the rural ones were underweight, OR = 2.25 (95% cr = 1.59, 3. 18), and a sign ifican tly higher proportion of the urhan than the rural students were stunted. The town and the rural students were not different regarding to 11' 1. This survey should sensit ize concerned bodi es for improving primary school chi ldren's health and nutrition. Recommendations are made to take actions to alleviate the IPI and nutritional problems of the school children.
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    An assessment of the Oral Health Status of Primary School Children in Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2000-12) Simon, Catherine; Tesfaye, Fikru(PhD)
    Although oral disease is a major public health problem, there is little epidemiological research in Ethi opia, This study is designed to provide base-line information on the major oral health problems among primary school children in Addis Ababa, A school-based cross-sectional study to assess the oral health status of primary school chi ldren aged 12 years and above, was conducted in Addis Ababa, in April 2000, A total of 1736 study subjects were chosen by multi-stage se lection procedll1'es from three different (private, public and government) types of schools, propOltionate to their size of student population, The overall prevalence of dental caries was 21,1 %, with no significant variation between the different types of schools, In this study, dental caries significantly increased with increasing age, high consumption of sweets and in those who do not clean their teeth, Periodontal disease affected more than half (53.4%) of the study subjects, Periodontal disease was significantly high in males, in public school children, in those whose consumption of sweets was high, in children having ' enjera' as staple diet and those with poor oral hygiene, The prevalence of malocclusion was 23,7% (22% mild and 1.7% moderate), Crowding of teeth was seen in 413 (23,8%) of children, The prevalence of spacing of teeth was 18.3%, More analytic studies have to be done to shed light on the determinant facto rs of malocclusion, spacing and crowding of teeth, The prevalence of dental fluorosis was low (l ,6%), affecting only 28 children , The knowledge and understanding of oral health and it's prevention was high but dental service utili sation was low, Initiation and strengthening of health education programmes 111 schools to include information about healthy diet and practice of adequate oral hygiene are recommended, Other recommendations are integration of oral health into primary health service and further studies to elucidate risk factors and treatment requirements for oral diseases, vii
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    The Effect of “Marriage by Abduction” on Child Survival in Meskan And Mareko District, Butajira, Ethiopia
    (Addis Ababa University, 2002-04) Kebede, Zelalem; Tesfaye, Fikru(PhD)
    A retrospective cohort study to assess the effect of “Marriage by Abduction” (MBA) on child survival was conducted from November 2001 to January 2002 in Meskan and Mareko District, Gurage Zone, Southern Nations Nationalities and peoples Regional Government (SNNPR). Data were collected using an anonymous structured questionnaire. A census has been conducted prior to the actual sample size determination and it produced a prevalence of 6.32% for “Marriage by Abduction” in the total population. A total of 1105 married women participated in the study. The ratio of marriage with and with out abduction was 1:3. Out of the total sample 954(86.3%) were from rural peasant associations(PA) and151(13.7%)from urban dweller association (UDA). Of all respondents 899(81.4%) were Muslims and 206(18.6%) were Christians. Majority of respondents 938(84.9%) were illiterate and 939(85%) were housewives by occupation. Of the total sample 244(22.1%) were married by abduction(exposed) and 861(77.9%) married with out abduction(non-exposed). The mean age of abduction was found to be 17 + 2.5SD. Among the abducted groups 17(7.0%) and among the non abducted 50(5.84%) experienced still birth in their life, and it was found that statistically not significant in biviariate analysis (p>0.502) Eighteen (7.4%) of the abducted and 71(8.2%) of the nonabducted women reported history of death of neonate with in 7 days after birth and it was found that statistically not significant in biviariate analysis(p>0.9305). Sixty seven (27.4%) and 235(27.2%) among those married with and with out abduction respectively, VI reported life time Infant death. The proportion of polygamous marriage in the abducted group was found to be 67 (27.5%) as compared to 212 (24.6%) in the non-abducted. In a focus group discussion conducted with both groups of women who married by or without abduction all of the participants condemned the practice of abduction, and reported that reconciliation by local elders after the act of abduction is one of the main reasons for the perpetuation of the problem. Infant or neonatal mortality was not found to be associated with “Marriage by Abduction” after controlling for possible confounders with logistic regression. Even if dealing with deep-rooted cultural problem is challenging, in this study it is recommended that sensitization and awareness creation addressing each segment of the population would help in alleviating the problem
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    Impact of Food and Nutrition Security on Adherence to Anti-Retroviral Therapy (ART) and Treatment Outcomes among Adult PLWHA in Dire Dawa Provisional Administration
    (Addis Ababa University, 2007-06) Seifu, Abiy; Tesfaye, Fikru(PhD); Shiferaw, Solomon(PhD)
    Background: Adherence to Anti-Retroviral Therapy (ART) is critical for optimal virologic suppression and improved CD4+ cell count that in turn determines the survival of People Living with HIV/AIDS (PLWHA) on ART. So far a range of predictors of adherence to ART in many different social and cultural settings have been identified. However, household food and nutrition security as predictor of adherence to ART is less understood. Objective: The main objective of this research project is to assess the effect of household food and nutrition security on adherence to ART and treatment outcomes. Method: A cross-sectional study was conducted to assess the effect of household food and nutrition security on adherence to ART and treatment outcomes. Both quantitative and qualitative research methods were applied to triangulate the findings of one with another. Adult PLWHA on ART for at least 3 months were the study participants. Availability of enough food/money to buy one, behavioral and subjective questions, meal frequency, dietary diversity, food aid and BMI were used as indicators to measure the household food and nutrition security situation of PLWHA and self-reported adherence as an indicator to measure adherence to ART. Change in CD4+ cell count, body weight, functional status and frequency of opportunistic infections were used to measure treatment outcomes. Result: Based on food security assessment core module close to 90% of PLWHA on ART in Dire Dawa were food insecure and 30.1% had at least mild malnutrition. On patient self report of adherence 96.6% of them were adherent to 95% of the ART drugs prescribed. The median change in CD4 count after 6 months and the median change in weight after 3 months of ART were 116 (IQR 82-182) and 3kg (IQR 1-6kg) respectively. Reported diarrhea and lung disease among the study participants were 17.9% and 54.1% respectively. Food and nutrition security indicators were associated with treatment Impact of food and nutrition security on adherence to ART and treatment outcomes AAU, FM, DCH, RH specialty track IX outcomes. Food aid contributed to functional improvement (OR 1.89, 95% CI 1.20-2.97). Dietary diversity and meal frequency were significantly positively correlated with change in weight and change in CD4 count respectively (p<0.05). Pre-ART nutritional status was significantly negatively correlated with change in weight after 3 months of ART (p<0.001). Discussion: Food and nutrition insecurity is a serious problem of PLWHA on ART. Overcoming all the odds to adhere to the treatment PLWHA in the present study were adherent to ART more than any documented adherence findings. But food and nutrition insecurity was silent factor that impede treatment outcomes. Food aid, dietary diversity and meal frequency were positively associated with functional improvement, weight gain and CD4 increase. Pre-ART nutritional status was negatively correlated with weight gain indicating better improvement among severely malnourished. Current malnutrition was significantly associated with reported opportunistic infections. Conclusion and recommendations: The mere success in achieving high level of adherence among PLWHA taking ART should not undermine the impact of food and nutrition security on the treatment outcomes which is the ultimate goal of the program. Lack of food to take with medication is the main reason for those few non-adherents and food ration improved functional status of PLWHA on ART. Food aid as relief together with a sustainable income generating activities need to be included in ART program.
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    The Influence of Social Marginalization on the Health and Nutritional Status of Women
    (Addis Ababa University, 2001-10) T/tsadik, W/medhin; Tesfaye, Fikru(PhD); Fantahun, Misganaw(PhD)
    The impact of social marginalization on the health of certain ethnic minority populations, particularly in women is a serious problem worldwide. However, its magnitude and factors are not well explored in developing countries in general and in our context in particular. Hence cross sectional, community based study with social group comparisons was conducted in Koysha Development Area of ActionAid-Ethiopia between January and December 2001. The study aimed at assessing the influence of social marginalization on the health and nutritional status of women. The study particularly focused on the health and nutritional status differences between the Manja and Malla social groups. All peasant associations within AAE-Koysha development program area were represented in the survey. The two study populations were stratified based on their social strata and selecting villages using probability proportionate to size technique enabled us to identify the required numbers of respondents. Data were collected using structured and pre-tested questionnaire, focus group discussions, in depth interviews and anthropomery. Data entry and analysis were performed using Epi Info and SPSS statistical software. The utilization of services for reproductive health problems by minorities (Manja social group) was low compared to the dominant Malla social group. There was a statistically significant difference between the two social groups in the use of antenatal care [OR = 2.93(1.39,6.25)], median number of antenatal care visit (p<0.05), and birth attended by trained traditional birth attendants or health professionals [OR = 4.61(1.75,13.17)]. The study also revealed that Mnaja women were at a reproductive health and nutrition disadvantage than their counterparts including, history of spontaneous abortions [OR = 1.71(1.08,2.72)], too many pregnancies [OR = 1.97(1.33,2.91)], grand multiparty [OR = 1.63(1.09,2.42)], and nutritional status as measured by MUAC <22.5cm [OR=3.34(2.05,5.39)]. viii From the study it is concluded that Manja mothers are discriminated in many aspects of social, economic and political processes. Manja mothers are at a greater risk of reproductive health and malnutrition (with regard to undernutrition) compared to the majority Malla social group. Scaling up of interventions to improve the livelihood of socially marginalised groups (Manja) in general and women in particular by all pro poor partners, including AAE is an area that needs to be emphasized in the future
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    Measuring Levels of Physical Activity among Adults in Miskan and Mareko District: A Validation Study
    (Addis Ababa University, 2004-04) Tadesse, Zerihun; Tesfaye, Fikru(PhD); Berhane, Yemane(Professor)
    According to a substantial body of evidence, regular physical activity can bring significant health benefits to people of all ages and abilities. Scientific evidence increasingly indicates that physical activity can extend years of active independent living, reduce disability and improve the quality of life of young and older adults. Despite these evidences, little is known about physical activity or its measurement on a population basis. A cross-sectional community based study was conducted to assess reliability and validity of instruments for measuring levels of physical activity. The instrument with better reliability and validity was used to measure levels and assess determinants of physical activity. Simple random sampling was carried out to recruit a total of 940 subjects. Global Physical Activity Questionnaire (GPAQ) and International Physical Activity Questionnaire (IPAQ) were administered to all participants during the first contact. The questionnaires were administered again after 4 days to a randomly selected sub-sample of 151 participants in order to assess reliability. Validity of the questionnaires was assessed on another randomly selected group of 186 study participants who wore motion monitor for seven consecutive days. A set of reliability tests indicated that GPAQ and IPAQ had good repeatability; balance in favor of the former. Validity of the questionnaires was assessed by a number of methods. Unlike reliability, validity was modest: percent correctly classified by concurrent validity of GPAQ against IPAQ for various domains of activity was between 35.9 and 42.5; gross vii misclassification was in the range 17.7-26.3%. In criterion validity test of the questionnaires against motion monitor, percent correctly classified was between 21.0 and 35.5 for GPAQ and between 25.3 and 38.2 for IPAQ; gross misclassification was in the range of 21.1-40.3% for GPAQ and 18.3-41.9 for IPAQ. The prevalence of physical activity measured by GPAQ was found to be 77%(724/940). Cumulative assessment of reliability and validity of questionnaires used in this study indicated that GPAQ and IPAQ were appropriate for use in our setting. However, conducting similar reliability and validity studies across different seasons and regions is strongly recommended before applying them on large-scale studies
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    Menarche, Menstruation related Problems and Practices among Adolescent High School Girls in Addis Ababa, 2003/04
    (Addis Ababa University, 2004-07) Abera, Yared; Tesfaye, Fikru(PhD)
    This is a school-based cross-sectional study conducted among female adolescents who were enrolled for 2003/04 academic year in Addis Ababa Secondary Schools. It was done as part of the curriculum for partial fulfillment of master degree in public health. Pathfinder International and Packard Foundation sponsored it. The study was conducted on randomly selected 863 students. The study looked at research questions such as age at menarche and its correlates; role of parents, schools and friends in the process of maturation; how they are prepared and dealt with menarche, and the current practices; and menstrual hygiene and suitability of school environment during menstruation with its effect on learning process. To reach at the desired objectives, different instruments were used. These were Pre-tested self administered questionnaire; Key informant interview, checklist for observation and focus group discussion. The study revealed that the mean age at menarche was (13.72±1.31) years. The dominant sources of information and advice on menstruation and how to deal with were teachers, mothers, elder sisters and friends. Fathers and brothers were the least consulted. Almost all girls hadn’t expected their menstruation when it happened for the first time. Seventy seven percent of them believed that menstruation was not a female matter which should be kept for oneself, not to talk of it openly to others; 54% of them hadn’t told any body. Girls preferred to get information on menstrual matters from female teachers, mothers, female health personnel friends and elder sisters in their descending order. The most felt needs during early days of menarche were menstrual soak ups and information. Sixty one percent of the girls used rag made soak ups during menarche while the current practice showed that only 52% of them used rag made. Seventy four percent of girls reported to have health problems related to menstruation where abdominal/backache and mood change were the most reported. Absenteeism due to menstruation related health problems was 51%, majority of them for one day when the occurrence of menstruation coincided with week days. vii In Addis Ababa adolescent girls reach at menarche while they are still in elementary schools, before they get sufficient information and counseling on menstruation or how to deal with it. Though most of the girls apparently had classes or obtained information on menstruation related facts that focused more on biologic and hygienic aspect, basically they didn’t address the psychosocial factors. This directly or indirectly may contribute to absenteeism. Besides this, the poor school facilities that couldn’t respond well to the needs of menstruating girls and lack of concern for its management at school are the areas that need attention. Hence, schools should provide the minimum acceptable, desirable and affordable standardized menstrual hygiene for girls. Health education or any education related to ARH, maturation process, should focus and complete the parent-student-teacher circle. Intervention programs focusing on school health should work in line with improving this situation as well as take this advantage as a good entry point to addressing other ARH problems including HIV/AIDS. Key words: Age at menarche, Menstrual Hygiene, Absenteeism due menstruation related health problems and Sexuality