Browsing by Author "Worku, Alemayehu(PhD)"

Now showing 1 - 20 of 22
  • No Thumbnail Available
    Item
    Adherence to Antiretroviral Therapy in Currently Changed Treatment Guideline on People Living with HIV/AIDS at Bishofitu Hospital, East Shoa, 2011. Ethiopa.
    (Addis Abeba Universty, 2011-01) W/tsadik, Asegid; Worku, Alemayehu(PhD)
    Background: Adherence to antiretroviral therapy (ART) is crucial to ensure viral suppression, decrease the risk of disease progression and drug resistance. Non-adherence to ART, likewise, is common in all groups of treated individuals & lack of strict adherence to ART is considered to be one of the key challenges to AIDS care worldwide. Objective: To assess adherence to ART on currently changed guideline and factors associated with it among People Living with HIV/AIDS (PLWHA) attending ART unit at Bishofitu Hospital. Method: A cross sectional survey of 317 clients attending for ART at Bishofitu Hospital was carried out using both quantitative & qualitative design method. Using a structured and pre-tested questionnaire, data on drug adherence and other variables was collected through in-depth interview, peer educators FGD, patient’s self report (interview), pill count and by reviewing their clinical records. The nurse & ART Clinician who are working in the ART unit were involved in data collection after being trained. Ethical clearance was obtained from concerned bodies and consent was sought from the study subjects. Adherence is defined as the number of doses taken divided by the number of doses prescribed over a given period. It is considered as good if the patient took ≥ 95% of the prescribed doses correctly. Odds ratio was done to determine the strength of association for different variables. Major Findings The overall prevalence of HAART adherence was found to be, 398(95.4%) in this study. The highest proportion, 61 % of patients missed or delayed their doses due to simply forgetting & 47.4% due to being away from home & 29.4% being too busy. Independent positive predictors of HAART non adherence reported in this study comprise:-the participants who had: PLWHA’s residency far from Bishofitu hospital (>47 KM.), depression feelings , ART eligibility knowledge, medication adverse effect, history active substance uses, no adequate social support & one or two children under their care in the final adjusted multivariate analysis. Conclusions & Recommendations: The prevalence of ART adherence among clients using currently changed single combined fixed dose in this study was found higher than most studies done in developed countries & even much higher than the findings of other studies in Ethiopia. From these, we can infer that single & simplified ART has reduced the pill burden & helped the clients to take it at ease & this has increased the level of adherence behavior of clients, therefore continuous effort should be made to increase clients’ awareness to maintain the best level of adherence outcomes.
  • No Thumbnail Available
    Item
    Application of Data Mining Technology to Predict Child Mortality Patterns: the Case of Butajira Rural Health Project (BRHP)
    (2002-06) Anagaw, Shegaw; Birru, Tesfaye; Worku, Alemayehu(PhD); Teferri, Dereje
    Traditionally, very simple statistical techniques are used in the analysis of epidemiological studies. The predominant technique is logistic regression, in which the effects predictors are linear. However, because of their simplicity, it is difficult to use these models to discover unanticipated complex relationships, i.e., non-linearities in the effect of a predictor or interactions between predictors. Specifically, as the volume of data increases, the traditional methods will become inefficient and impractical. This in turn calls the application of new methods and tools that can help to search large quantities of epidemiological data and to discover new patterns and relationships that are hidden in the data. Recently, to address the problem of identifying useful information and knowledge to support primary healthcare prevention and control activities, health care institutions are employing the data mining approach which uses more flexible models, such as, neural networks and decision trees, to discover unanticipated features from large volumes of data stored in epidemiological databases. Particularly, in the developed world, data mining technology has enabled health care institutions to identify and search previously unknown, actionable information from large health care databases and to apply it to improve the quality and efficiency of primary health care prevention and control activities. However, to the knowledge of the researcher, no health care institution in Ethiopia has used this state of the art technology to support health care decision-making. Thus, this research work has investigated the potential applicability of data mining technology to predict the risk of child mortality based up on community-based epidemiological datasets gathered by the BRHP epidemiological study. The methodology used for this research had three basic steps. These were collecting of data, data preparation and model building and testing. The required data was selected and extracted from the ten years surveillance dataset of the BRHP VIII epidemiological study. Then, data preparation tasks (such as data transformation, deriving of new fields, and handling of missing variables) were undertaken. Neural network and decision tree data mining techniques were employed to build and test the models. Models were built and tested by using a sample dataset of 1100 records of both alive and Died children. Several neural network and decision tree models were built and tested for their classification accuracy and many models with encouraging results were obtained. The two data mining methods used in this research work have proved to yield comparably sufficient results for practical use as far as misclassification rates come into consideration. However, unlike the neural network models, the results obtained by using the decision tree approach provided simple rules that can be used by nontechnical health care professionals to identify cases for which the rule is applicable. In this research work, the researcher has proved that an epidemiological database could be successfully mined to identify public health and socio-demographic determinants (risk factors) that are associated with infant and child mortality in rural communities.
  • No Thumbnail Available
    Item
    Assessment of Adherence to Antiretroviral Therapy among HIV-Infected Persons in the Ministry of National Defense Force Hospitals, Addis Ababa and Debreziet
    (Addis Abeba Universty, 2005-04) Mengesha, Ayalew; Worku, Alemayehu(PhD)
    A stratified cross-sectional survey supported by qualitative approach was conducted on 422 HIVinfected persons receiving antiretroviral regimens from the Ministry of National Defense Force Hospitals, in Addis Ababa and Debrezit. The study was focused on the assessment of adherence to ARV therapy among HIV-infected persons from October 2004 to March 2005. The study group consists of three categories namely Officers, private and non-commissioned officers and civil. All 422 HIV-infected patients received ARV treatment for a mean duration of 3.7 months, were interviewed using pre-tested questionnaire and in depth interview to six selected cases. Adherence was measured using self report; participants were questioned regarding taking the total number of ARV pills prescribed by physician and the memory aids used to remind the prescribed regimens. The finding revealed that among the respondents who already started ARV therapy 160 (39.5%) were civil, 158 (37.6%) were private and non-commissioned officers, 96(22.4%) were officers. The median age was 35 years (interquartile range 29-40) and 284(67.3%) were males. The average adherence rate to ARV medication was 82.8% of all prescribed doses. Keeping clinical appointment, using memory aids and educational levels were associated with increased adherence. The incidence of opportunistic infections were higher in the study population before initiation of ART. The most frequent opportunistic infections were oral candidasis and pulmonary tuberculosis, both diseases decreased by three-fourth after the initiation of ART when comparing for the same patients. The frequency of AIDS-related infections declined dramatically by 83.3% after the initiation of ARV treatment and AIDS-related hospitalization is reduced by 44.7%. Of the total respondents 4(0.7%) of the patients developed serious adverse drug reactions requiring a change in treatment. It was concluded that most patients need aggressive modification to improve their adherence to ARV treatment. The findings suggest that develop patient centered education approach that ensure a good understanding of treatment by the patient on the help of memory aids and keeping clinical appointment.
  • No Thumbnail Available
    Item
    Assessment of Home Management of Fever/ Malaria in Under-Five Children in Dembia District, Northwest Ethiopia
    (Addis Ababa University, 2005-04) Tefera, Worku; Worku, Alemayehu(PhD)
    Background: Malaria kills more than 1 million people every year in the world, 90% of them in Sub-Saharan Africa; the majority of them are children under five years old. Early diagnosis and prompt access to treatment is the main strategy to reduce morbidity and mortality due to malaria. In Africa, evidences indicate that 70% of malaria cases in rural areas and about 50% of the cases in urban areas treat malaria first at home. Though prompt access to treatment within 24 hrs of onset of fever is appropriate, studies indicate that there is a poor, inadequate and inappropriate practice of treating fever/malaria in many developing countries. Objective: The purpose of this study was to assess knowledge, attitudes, practices, and beliefs (KAPB) about a home management of malaria in under five children. Methods: A cross-sectional study using qualitative and quantitative data collection methods were conducted in rural area of Dembia District, North Gondar, Amhara, Northwest Ethiopia. Multistage sampling technique was used to select randomly 517 households/ mothers (caregivers) of under-five children from 4 randomly selected Peasant Associations. Data were collected from 515 subjects using structured questionnaire. Focus Group Discussions and Key informants' interviews were conducted. The data were analyzed using EPI INFO version 6.04 and SPSS version 11 statistical packages. Results: The study subjects had a better knowledge about symptoms of mild malaria, such as fever (99.4%), head ache (97.6%), chills and shivering (99.6%), poor appetite (95.1%), vomiting (98.2%) and joint and body pain (94.9%), but could association of the mosquitoes with malaria to lesser extent (69.9%), while majority of them attributed its cause to cold or changed weather (83.7%) and to stagnant water (77.1%). Most respondents believed malaria is preventable (85.8%). They practiced preventive methods such as Environmental management (74.4%), DDT spray of households (53.8%), and bed net use (3.4%) to prevent malaria. Home Management of malaria/fever is practiced in the area in a high proportion of the under 5 children (45.2%) with modern anti-malarial drugs. vi Reasons mentioned for delayed health care seeking of caregivers for fever or malaria were hoping the child will be well or taken to traditional healer (50.8%), far distance (27%), and shortage of money (7.7%). Conclusion: The knowledge of caregivers about symptom of malaria and their practice to prevent the disease was very high. However, they could associate mosquitoes with malaria to a lesser extent, and most of them had also misconceptions about its causation. Home treatment of fever/ malaria was found to share a major part in the health service provision in under-five children in the area. Recommendations: Thus, design of effective malaria communication strategy; training and motivation of community health agents and mothers to treat cases promptly and properly; and strengthening the link between private-public health sector partnerships with the community were recommended.
  • No Thumbnail Available
    Item
    Assessment of Magnitude and Factors Associated with Premarital Sex among Preparatory Students, Bishoftu Town Oromia Region
    (Addis Ababa University, 2013-02) T/Mikael, Wendifraw; Worku, Alemayehu(PhD)
    Background: - Premarital sex results not only expose to STDs including HIV and AIDS, but also unwanted pregnancy for females. In addition, unwanted pregnancy among female students may lead to school dropout and a failure to complete their education. Therefore, studying about the magnitude and factors associated with premarital sex among in school youth in this area is an essential issue to overcome young people from sexual related problems and to support programmers and policy makers in providing information. Objectives: - The objective of this study is to assess the magnitude and factors associated with premarital sex. Methods: - a comparative cross sectional study that employed quantitative data collection method was used. The study was conducted on May 2013 in Bishoftu preparatory school among 530 students (265 male and 265 female students). Bivariate analysis was used to describe some of the socio-demographic variables, and logistic regression model was used to measure the association of outcome variables of different characteristics of the study subjects. Results were presented using tables and figures. Result: Out of 530 samples size 504 participated in the study. About 21.6% of the respondents were sexually active; the majorities were females within the age group of 20-24 years. More than half of the sexually active students (59.6%), had their first sexual intercourse in the age group of 15-18 years, mean (+SD) age of first sexual contact were found to be 18.24(+1.493) years respectively. Twenty one percent of the respondents had multiple sexual partners and among the sexually active students 57.8% never used condom at first sex. Age, living arrangement (living with friends ), go to Bars, narcotics intake, pornography film or magazine and peer pressure for doing sex were found to be significantly associated with premarital sex(AOR: 0.550, 95%CI: 0.316, 0.956), (AOR: 3.678, 95%CI: 1.180, 11.463), (AOR: 6.802, 95%CI: 3.540, 13.067), (AOR: 7.471, 95%CI: 1.849, 30.193), (AOR: 3.000, 95%CI: 1.700, 5.295), (AOR: 2.915, 95%CI: 1.687, 5.038), respectively. Conclusion and recommendation: -From this study, one can conclude that there is a high prevalence of premarital sexual practices among youths. Therefore, an integrated effort needs to be initiated to address such youths sexual and reproductive health problems through ICC/BCC services about sexual and reproductive health in general and premarital sex and its consequences in particular within the school environment
  • No Thumbnail Available
    Item
    Assessment of Sexual behaviour, Attitude and Risk Perception about HIV/AIDS among out-of-school Anti-AIDS club member and non member youths, Mettu and Bedelle towns, Ilu-Abba-Bora Zone Western Ethiopia. A case control study
    (Addis Abeba Universty, 2010-06) Legesse, Elias; Worku, Alemayehu(PhD)
    Background: Young people today are at high risk behavior that could expose them to HIV/AIDS and other STIs and threatened by HIV/AIDS epidemic since they are sexually active at younger ages and low and/or inconsistent use condoms to ensure protection. Objective: To assess sexual behavior, attitudes and risk perception about HIV/AIDS among outof- school anti-AIDS club member and non member youths in Mettu and Bedelle towns. Methods: The study applied a case control study design in which the behavior difference between club member and non-club member groups examined. The cases are club members those registered in the out-of-school anti-AIDS club and actively participated for at least one year. Controls are non-club member who have never been registered and never became active member of any anti-AIDS club anywhere in the towns. A pre-tested self-administered questionnaire was used to collect data. Focus Group Discussions was also conducted in the two groups to complement the quantitative findings. Results: From a total of 786 youths, 386 club member and 400 non-club member participated in the study. In this survey two third of the club members, (66.6%) & one third of the non-club members, 33.2% reported to have practiced sexual intercourse in the past. Females were likely more to start sexual practice at age than males in both groups. Among cases 31.3% reported that they had two and more than two sexual partners over the past and 29.2% controls reported that they had more than two sexual partners. Forty five point nine percent of club members and 33.3%of non-club members had used condoms during the first time they had sexual intercourse. The majority (99.1%) of the study populations were aware of HIV/AIDS. Seventy two pointy five percent of club member and (54.7%) non-club members perceived that they are at risk or may be at risk of acquiring the HIV/AIDS. The majority (74.6%) of the club members, and 52% of the non-club member youths expressed their willingness to undergo VCT for HIV. The prevalence of multiple sexual partnerships over past year among both groups was 30.3% in the selected towns. FGD also supplements that both groups admitted that youths in the towns engaged in risky sexual behaviors such as unprotected sexual intercourse which is the main cause of the spread of HIV/AIDS in the both towns. Conclusion: The finding of the survey concluded both club member and non-club member outof- school youths in this study area were exercising high risky sexual activities like early sex, multiple sexual partners, and inconsistent use of condom. But, the percentage among club members was lower than non-club members. Being a club member is protective for HIV/AIDS related risky sexual behaviors, perception. So, it was recommended that IEC on sexual health should be given intensively by concerned bodies to make adolescents protect themselves from these behaviors.
  • No Thumbnail Available
    Item
    Assessment of the Magnitude and Awareness of Delay of Sexual Activity Among Unmarried Youths (Aged 20 To 24 Years) to Prevent HIV/AIDS and Other STDS In Metu Town, Ethiopia
    (Addis Ababa University, 2005-04) Ayana, Yadeta; Worku, Alemayehu(PhD)
    The various reasons that could be mentioned for the adolescents’ unable to delay sexual activity were a socio-economic and socio-cultural environments that enhance the inception of sex at an early age. The main objective of the research was to assess the magnitude and awareness of delay of sex that contribute to or retard the spread of HIV/AIDS and other STDs in youths where the degree of the problem had not been known. The study design used was cross sectional encompassing both quantitative and qualitative study methods of data collection. Using the probability sampling technique, 460(218 females and 242 males) town resident youths unmarried (aged 20 –24 years) were selected from the four kebeles by systematic random sampling for the interview. A structured questionnaire and four focus group discussion sessions were used to collect the data. Moreover, thirteen in-depth interviews were utilized. Seventy (fifteen percent)and 63(13.7%) of them were males and females of 20 years of age respectively. The mean age of the survey respondents was found to be 21.61±1.35 whereas the median age was 23 year. One hundred ten (45.5%) of males and 77(35.3%) of females had commenced sexual intercourse. The mean and the median ages at the first sexual debut were 17.12±2.05 and 17 years respectively. Three of the female respondents commenced sexual intercourse at 10 years of age. Majority of them attended school where 45% of them had accomplished secondary education. Interest of an individual youth, peer pressure, substance abuse, loss of one or both parents and had not been raised up by biological parents were some of the contributing factors for the initiation of early sex whereas passing several years at school, fear of HIV/AIDS and other STDs were few of the factors to enhance delay of sex. Finally, this result is to be utilized for the development of appropriate strategies and programs for interventions that will enable the xii youths to be protected from high-risk sexual behavior and hence postpone early sexual intercourse until later age/until marriage
  • No Thumbnail Available
    Item
    Clinical Presentation, Treatment Outcome and Survival of HIV Positive Tb Patients on Short Course Dots in Hawassa Health Center
    (Addis Abeba Universty, 2010-06) Shaweno, Debebe; Worku, Alemayehu(PhD)
    Background information: In contrast to, many initiatives implemented to tackle Tuberculosis, many countries have not so far reached the targets set by WHO. The main reason mentioned so far was the impact of HIV infection. Therefore, it is essential to determine the impact of HIV/AIDs on the clinical presentation and treatment outcome of tuberculosis locally. Objectives: To compare clinical presentation, treatment outcome of TB and on treatment survival among HIV positive and negative TB patients who are through (DOTs). Methods: A retrospective cohort study design was employed to compare the clinical presentation of TB and its respective treatment outcome between the exposed; HIV positive (n=370) and non exposed; HIV negative TB patients (n=370) who were through the short course DOTs in Hawassa Health Center from 2006-2010. Patient’s HIV status during the diagnosis of TB or initiation of DOTs was considered as an exposure and TB treatment outcome was considered as the outcome variables. Standard WHO definition, is used to classify tuberculosis cases and TB treatment outcomes. Results: Smear negative PTB was significantly the frequent presentation, 0.32, 95%CI (0.25, 0.39; Z=8.76, P=0.000) among HIV positive study subjects, while significant difference in proportion of smear positive PTB; (-0.26; 95%CI (-0.33 -0.19; Z=-6.25, P=0.000) was in favor of HIV negative individuals. Compared to HIV negative TB patients ,cure rate was substantially lower in HIV positive TB patients (73% vs. 87.9%, z=-2.5, P=0.04), and the risk of death was statistically higher among TB/HIV co infected patients; AHR=1.6, 95%CI(1.01-2.6) during the course of DOTs. Regarding survival of TB patients, the survival probability was lower for HIV/TB co infected patients (Log rank test= 6.90, df= 2,P= 0.008).When adjusted for covariates, the survival probability is below 15% for HIV positive but above 85% in HIV negative TB patients at the end of DOTs period(8th month). The independent predictors of death, while on treatment are age, weight and HIV infection. Conclusion: On TB treatment survival probability and cure rate are substantially lower in HIV infected TB patients due to an increased death and unfavorable treatment out comes for the former and the later respectively. Therefore targeted and comprehensive management of TB should be considered in this group of patients. Key words: Clinical presentation, treatment outcome, survival of TB patients, Hawassa health center
  • No Thumbnail Available
    Item
    Determinant Factors of Womens towards Modern Health Care Seeking Behavior for Childhood Diarrheal Disease in Hetosa District, Arsi Zone
    (Addis Abeba Universty, 2011-05) Mamo, Ephrem; Worku, Alemayehu(PhD)
    Background: Diarrheal disease remains one of the principal causes of morbidity and mortality in children of developing countries. One major reason for the poor outcomes of diarrheal episodes is the mother’s treatment of diarrheal disease at her home and the kind of modern treatment she seeks. Objectives: To assess mothers’ modern health care seeking behavior and its determinants for childhood diarrheal illnesses in Hetosa District,Arsi Zone, Oromia region. Methods: a comparative cross sectional study was conducted from December 2010-January 2011 in Hetosa Woreda, Arsi zone, Oromia region. The study participants were 434 mothers/caretakers who had at least one under five years old child with diarrhea in the previous four weeks and selected from eight kebeles and one town. Data were collected using structured questionnaire and entered through Epi enfo version 3.5.1 and analyzed by SPSS version 16. A distractive statistics, bivarate and multivariate analysis was done using cross tabulation and binary logistic regressions. Results: the study revealed that residence, excretal disposal method, income, distance of health care facilities and educational status of the mothers or care takers were significantly associated with mother’s modern treatment seeking behavior. Mothers who live in urban were four and half times sought modern treatment than rural dwellers, [OR(95%CI)=4.49(2.07, 9.7)].Mothers of those grade 9-12 were nine times more likely to seek modern treatment than illiterate one[OR(95%CI)=8.88(1.15, 68.6)]. Those households used latrine and income greater than 500 per month were 4.6 and 3.3 times more likely to seek modern treatment than who use open field and earn less than 500 Ethiopian birr respectively,[OR(95%CI)=4.62(1.84,11.6)]and [OR(95%CI)=3.31(1.45, 7.54)]. Concerning the composition of fluid given, only 38.8% of the mothers used oral rehydration therapy (ORT) (ORS and RHF) while the rest of them gave soup (36.2%) and others (25.2%) such as plain water, tea, raw milk and traditional remedies which are generally not as such helpful for the diarrheal child. Conclusion: Majority of study mothers perceived that contaminated food is the major cause of childhood diarrhea. But there were mothers perception on childhood diarrhea those not treated by modern treatment. Regarding Mothers seeking behavior of modern treatment mothers who live in urban was more likely seek modern treatment than rural dwellers.
  • No Thumbnail Available
    Item
    Determinants of HIV Testing among Tuberculosis Patients on Dots in East Wollega Zone, Ethiopia
    (Addis Abeba Universty, 2011-04) Agero, Gebi; Worku, Alemayehu(PhD)
    Background: Tuberculosis is the most common cause of death among people living with Human Immunodeficiency Virus. The World Health Organization recommends that in countries where HIV prevalence is at least 1% among adults and 5% among Tuberculosis patients, all Tuberculosis patients should be offered HIV testing and all People living with HIV should be screened for Tuberculosis. To increase uptake of HIV testing, it also recommends provider initiated HIV testing and counseling. Objectives: The objective of this study was to assess determinants of HIV testing among Tuberculosis patients on DOTS in East Wollega zone, Ethiopia. Methodology: Institution based case control study design was conducted from January – March 2011. Both quantitative and qualitative approaches were used. Cases were tuberculosis patients who have not accepted HIV testing while the controls were those who have accepted HIV testing. A sample of 270 (90 cases and 180 controls) tuberculosis patients, with a ratio of two controls to one case, was used. Simple random sampling technique was used to recruit study subjects and SPSS Version 17 was used for quantitative analysis while verbatim was used for qualitative data. Result: Tuberculosis patients who have tested for HIV have heard their HIV test result in which 23(12.8%) of them were HIV positive and 157(87.2%) of them were HIV negative. The proportion of HIV infected individual was 10(13.2%) among males and 13(12.5%) among females, while its 19(16.4%) among TB patients from urban and 4(6.2%) among those from rural area. Tuberculosis patients having low knowledge about HIV were more likely to reject HIV testing AOR 3.697 (CI 2.135, 6.402) compared to those who are knowledgeable about HIV. Higher level of stigmatized attitude toward HIV and being from urban were also associated with rejecting HIV testing AOR 3.421(CI 1.870, 6.257) and AOR 5.692(CI 1.930, 16.783) respectively. Conclusion: Efforts to promote HIV testing utilization require effective strategies to reduce stigmatizing beliefs towards HIV and PLWHA among TB patients. Health information dissemination regarding HIV testing and risky sexual behavior reduction should have to be targeted most at risk population like tuberculosis patients.
  • No Thumbnail Available
    Item
    Determinants of Provider Initiated HIV Counseling and Testing among patients visiting Health Care Facilities in Sheka Zone, South West Ethiopia
    (Addis Abeba Universty, 2010-07) Dakito, Asaminew; Worku, Alemayehu(PhD)
    Background: Ensuring widespread access to and utilization of HIV testing is a central element of a successful response to HIV/AIDS. Increasing the number of people who know their HIV status is an essential means of preventing HIV transmission and of improving the reach of treatment and care services. World Health Organization recommends; all adult patients visiting health facilities should be provided PIHCT as way forward in generalized HIV epidemic setting. Ethiopia has adopted routine HCT since 2007.After implementation of policy the magnitude and possible factors associated with accepting PIHCT were not well documented in Ethiopia in general and sheka zone in particular. Method: Cross-sectional comparative study was employed in order to identify different factors contributing to accepting and non-accepting. Total of 484 subjects 363 acceptors and 121 non-acceptors were selected among physically and mentally capable of giving consent (as part country policy) patients Three acceptors were taken for each non acceptor .Face to face interview was employed using structured questionnaire. For data management and analysis SPSS 11 and Epi –info3.3.2 statistical soft wares were used. Result. Fear of learning own HIV status, confidentiality and less risk perception were mentioned by majority of respondents as barrier of HIV testing. Also some attitude were highlighted as potential barriers ; PIHCT may lead to more violence against women related to test and may lead to avoidance of seeking other health care services for fear of HIV test. After all, being male, (AOR=2.02 CI (1.21, 3.36)) having previous history of HIV test (AOR=2.65 CI (1.60, 4.41)) and belief that ART can improve health of patients (AOR=0.45 CI (0.23, 0.90)) were found to be predictors of PIHCT acceptance. Conclusion and Recommendation: In order to address universal access, implementers should take the above potential barriers under consideration .The authors believe emphasizing on informed consent, confidentiality and counseling can potentially solve most of the problems.
  • No Thumbnail Available
    Item
    The Effect of HAART on Incidence of Tuberculosis among HIV Infected Patients in Hawassa University Referral Hospital, South Ethiopia
    (Addis Ababa University, 2011-04) Solomon, Tarekegn; Worku, Alemayehu(PhD)
    Background Information: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of tuberculosis in both Antiretroviral Therapy receiving and Antiretroviral Therapy naïve Human Immunodeficiency Virus infected patients. Tuberculosis incidence and factors that contribute for development of tuberculosis in era of Antiretroviral Therapy were poorly described in Ethiopia. Objective: To examine the effect of HAART on incidence rate of tuberculosis and tuberculosis free survival among HIV-positive adults in HAART receiving and HAART naïve groups enrolled to ART clinic in Hawassa University Referral Hospital. Method: A retrospective cohort study design was used on 632 HIV-positive adults with age 15 years old and above enrolled to ART clinic in Hawassa University Referral Hospital over a three-year period. Incidence rate of tuberculosis and TB free survival was calculated and compared for Pre-HAART and HAART follow up HIV/AIDS patients. In this study, patients who followed on Pre-HAART are considered as unexposed and patients who receiving HAART considered as exposed, and was followed for three years from July 2006 to January 2011. Result: A total of 632 patients (316 in ART and 316 in ART cohort) followed for a median of 32.9(IQR=17.6-36.5) months in Pre-HAART and 35.4 (IQR=23.6-36.5) months in HAART cohort. TB incidence rate was 3.5 and 7.2 per 100 PYO in HAART and Pre-HAART cohort respectively. Over all chance of not developing TB was high in HAART cohort (Log rank=8.24, df=1, P=0.004). Being on HAART (AHR=0.182, 95%CI=0.078-0.424, P<0.001), being married (AHR=0.354 95%CI=0.191-0.655, P=0.001) and widowed (AHR=0.375, 95%CI=0.169-0.831, P=0.016) were factors related to decreased TB incidence. WHO stage 3 or 4 (AHR=1.999, 95%CI=1.025-3.896, P=0.042), being bedridden (AHR=4.689, 95%CI=1.715-12.819, P=0.003), and having hemoglobin level less than 10mg/dl (AHR=2.497, 95%CI=1.098-5.679, P=0.036) were factors associated with increased risk of TB at multivariate analysis. Conclusion: HAART decreased new cases of tuberculosis by 81.8% compared to HAART naïve patients and the probability of not developing TB was higher in HAART cohort than Pre- HAART. The finding is similar level with other developing and developed countries, but still gross TB incidence rate was high in both Pre-HAART and HAART cohort when compared with developed countries. More efforts have to be taken to reduce TB incidence as level of most developed countries have achieved many years ago
  • No Thumbnail Available
    Item
    Ethiopia Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba Universty, 2017-05) Walle, Fisseha; Worku, Alemayehu(PhD)
    Background: Influenza and influenza-like-illness (ILI) is the most contagious respiratory diseases having substantial public health problem. It is associated with higher morbidity and mortality during outbreak, especially among the elderly and children. The aim of the study was to identify existence of outbreak, etiologic agent, magnitude, associated factors with ILI to contain the outbreak. Methods and materials: We conducted unmatched case-control study in Jawi district from 29 February through 10 March 2016 G.C. We enrolled 28 cases and 112 controls. We conducted face to face interview using structured questionnaire. Data were entered and analyzed using Epi-Info and SPSS. We performed binary logistic regression analysis to explore predictors of ILI. Results: From 29 February through 10 March 2016, we identified 28 cases (attack rate, 20.55/100,000) and no death. From total cases, 4(14.29%) confirmed and 8 (28.6%) admitted cases were reported. Female cases were 67.9%. Majority affected age groups were <5 and ≥ 65 years with attack rates of 37.95 and 25.23 per 100,000 risk populations respectively. In multi variable analysis [AOR (95% CI)]: being female [3.76(1.23, 11.52)], family size ≥5 [4.56(1.24, 16.79)], having contact history with suspected ILI [5.57(1.64, 18.89)], living in ventilated house [0.14(0.04, 0.42)], and having knowledge to ILI [0.1(0.01, 0.91)] were associated factors. Conclusion and recommendation: Most of the cases were females and under five children. Being female, living in large family size and having contact history with ILI were statistically significant risk factors; whereas living in ventilated house and having knowledge to ILI were protective factors. Health education should be continued to successfully contain the outbreak. The community should improve the ventilation status and room space of the house. Key words: Influenza like illness, associated factors, Jawi district, Ethiopia.
  • No Thumbnail Available
    Item
    Ethiopian Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba Universty, 2014-05) Zemelak, Etsehiwot; Worku, Alemayehu(PhD)
    Introduction: Measles is a highly contagious disease and remains the leading cause of childhood morbidity and mortality in the world. In Ethiopia measles accounts four percent of childhood mortality. On October 2, 2013, a suspected outbreak of measles was reported in Kindo Didaya woreda, SNNP region. We investigated to identify risk factors and to institute prevention and control measures. Methods: A 1:2 unmatched case control study was conducted, with 50 cases and 100 controls. A measles case was defined as illness characterized by fever, rash, and either cough, coryza or conjunctivitis. Controls were individuals who had no clinical signs of measles and were randomly selected from the same communities where cases were identified. Blood samples were collected for laboratory investigation. Result: The mean age for cases was 8.4 (SD +/- 7.4) years while for controls were 8.6 (+/- 6.7) years old. A total of eight deaths with case fatality rate of 1.4% were attributed to this outbreak. All the collected five samples were measles IgM positive. Not being vaccinated (OR=6.62; CI: 2.29-19.10), having contact with suspected or confirmed cases (OR=12.6; CI: 3.52-39.62) and mothers illiteracy (OR=4.75; CI: 1.51-12.38) was associated with contracting measles. Conclusion: There was an outbreak of measles in Kindo Didaya woreda. Being un-vaccinated, having contact with suspected or confirmed case and mother‘s illiteracy were associated with contracting measles. Vaccination of children‘s aged six months- 14 years; case management and public health education were instituted as a prevention and control measure. Keywords: Measles outbreak, kindo Didaya, Southern Ethiopia
  • No Thumbnail Available
    Item
    Examination of the Levels and Determinant Factors of Fertility and Contraceptive use in Northwest Ethiopia: With Special Reference to the Application of the Bongaarts’ Model
    (Addis Ababa University, 2009-02) Degu, Getu; Worku, Alemayehu(PhD)
    Background: Nearly two million people are added to the population of Ethiopia each year. It is the second most populous country in Africa (next to Nigeria) and usually quoted as one of the demographic giants on the African continent. It has now become clear that uncontrolled fertility has adversely influenced the socio-economic, demographic and environmental situations of Ethiopia. Rapid population growth has hampered its development making the eradication of extreme poverty and hunger difficult. The country has experienced many man made and natural disasters. This undesirable situation is further aggravated by rapid population growth. In spite of the rapid population growth in Ethiopia in General and in the Amhara region (especially in the two Gondar Zones) in particular the contraceptive prevalence rates are reported to be low. Objectives: A number of distinct objectives that addressed several issues which ultimately led to the examination of fertility and the use of family planning methods were employed. Efforts were made to estimate the fertility rates and quantify the contribution of each of the proximate determinants of fertility that bring fertility below its biological maximum in North and South Gondar Zones of Northwest Ethiopia. It was also aimed at identifying the factors influencing fertility and investigating the perception of the study subjects towards rapid population growth. Moreover, efforts were made to closely explore the current practices and future intentions of the study subjects towards contraception. Methods: The study had two components. The first one was a quantitative study which involved 3512 women aged 15 to 49 years. The second component was a qualitative study which consisted of five focus group discussions and ten key informant interviews
  • No Thumbnail Available
    Item
    Factors associated with utilization of institutional delivery among mothers in the Butajera Health & Demographic Surveillance System, Ethiopia, 2013. A case control Study
    (Addis Abeba Universty, 2013-06) Eyob, Bezawit; Worku, Alemayehu(PhD)
    Background: Maternal mortality is unacceptably high. Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. An important component of efforts to reduce health risks to mothers and children is increasing the proportion of babies that are delivered in health facilities. Ethiopia has one of the highest home delivery practices, as the 2011 EDHS report shows home delivery prevalence was 90%. To improve maternal health, barriers that limit utilization and access to delivery services must be identified and addressed. Objectives: The objective of the study is to asses factors associated with institutional delivery among mothers in the Butajera Demographic and Surveillance System. Method: A community based case control study supplemented with a qualitative study was conducted to identify factors associated with utilization of institutional delivery. The study was done using the Butajera demographic surveillance system. Women who have given birth in health institution in the past one year was considered as Cases while the controls were women who have given birth at home in the past one year. The quantitative data was collected using a pre-tested and structured questionnaire and four FGDs and four in-depth interviews were done using interview guide. To assess the association, bivariate analysis was done. All independent variables with p-value less than 0.05 were included in the final multivariate logistic regression model. Result: The final multivariate regression model has shown that the main determinant factors of utilization institutional delivery service are age of mother, residence at the time of delivery, place of previous deliveries, decision maker about place of delivery and history of health problem during last delivery. While being young in age and history of health problem increased utilization of IDS, residing in rural area was found to be preventive of utilization of IDS. In addition both mothers who have all their deliveries in health institution and those who have all their deliveries in their home will follow the same pattern as their previous experience. The qualitative part of this study has shown that mothers are not convinced about the services and the health professionals in health institutions. Conclusion: In conclusion, mothers in urban areas, who never used IDS and older at age were found less probable to use IDS, hence due attention should be given to this group of women to improve utilization. The government and health professionals should educate mothers and advocate delivery service in order to change the outlook of the community towards IDS.
  • No Thumbnail Available
    Item
    The Interrelationship between Population Dynamics and Childhood Mortality in Butajira District, South Central Ethiopia
    (Addis Ababa University, 2012-06) Mekonnen, Wubegzier; Worku, Alemayehu(PhD)
    The population of Ethiopia is still growing by 2.6% per annum mainly due to high fertility of 4.8 children per woman. Though increasing in the current decade, only about a quarter of married women used family planning methods in 2011. Though early childhood mortality diminished in recent years, this decline was not statistically significant in infant mortality. Levels and extent of reductions in the three components of population change and their relationships varied across different regions and by urban-rural setting in the country. Previous studies elsewhere showed relationship between population dynamics and health. Studies also revealed that intervention in one component of population change affects another component. A body of literature on insurance and replacement fertility response of childhood mortality were documented in least developing countries. Moreover, selection, disruption, adaptation, environmental theories had also documented the relationship between migration with fertility and under-five mortality. Migration might select people with different fertility behavior and childhood mortality experience compared to those without such behavior. If those with less number of children migrate, the fertility and child mortality of non-migrants in the place of origin would be inflated compared to those of the migrants. Among the latter group, the disruption due to migration might contribute to reduction in fertility or increase in early childhood mortality. Besides, the group might adapt the fertility behavior of the population in the area of destination. In this regard, this thesis aimed at measuring levels of and assessing relationships between fertility, contraception, under-five mortality and migration in the designated area of the study. It also tried to identify main proximate and distal factors of each of these components of population change in the context of the recently introduced village-based health extension program, reproductive health strategy and population policy in the densely populated Butajira District of South Central Ethiopia. Methods The study was hosted by the Butajira Demographic Surveillance System which is located about 135 kms from Addis Ababa in the southern direction. Qualitative and quantitative methods were employed in this study. The quantitative research used two data sources. The longitudinal surveillance database up to the end of 2008 was extracted to recruit study women of reproductive age for the cross-sectional study which aimed at measuring levels and identifying determinants of fertility, contraception and the unmet need of family planning. The database was also used to have a detailed insight into early childhood mortality and out-migration in the district. Standard data collection instruments of the INDEPTH-Network and Measure DHS were contextually adapted for the longitudinal database and the cross-sectional survey respectively. A priori focus group discussions were held to incorporate the community’s terminologies and opinions. A total of 11,133 women of reproductive age were recruited from the surveillance database and 9,996 of them responded positively. Especially trained and experienced field staff collected the data. There was rigorous supervision. Data sources were managed by softwares having internal consistency checking mechanisms. Cleaning was done at desk. Serious anomalies were taken back to the field for reconciliation, while others were rectified by imputing values from logical flows in the questionnaire. Frequency distributions, cross-tabulations and graphical presentations were done. Event history analysis was used to calculate person time of exposure, incidence and prevalence rates using longitudinal data. Odds ratio along with the 95% confidence interval in binary logistic regression was used to determine association between covariates and the binary outcome of interest. In the case of fertility, Bongaart’s model to measure the inhibition effects of proximate determinants and the incidence rate ratio in Poisson regression along with the 95% confidence interval was used to measure the association between fertility and covariates. Poisson regression was also used to measure associations of background characteristics with out-migration and under-five mortality. Assumptions of all the statistical models used in this study were checked. Results The total fertility rate of 5.3 children per woman was high and comparable to the rest of Ethiopia with rural-urban disparity (Highland, TFR=5.7, Lowland, TFR=6.6 and Urban, TFR=3.3). Postpartum infecundability due to breastfeeding (Ci=0.68) significantly deducted fertility from its biological maximum. The contribution of contraception (Cc-u=0.57, Cc-e=0.43) and nonmarriage (Cm-u=0.53, Cm-e=0.41) was important among urbanites and educated women. Abortion contributed a significant role to reduce fertility among school youth (Ca=0.76). The fertility incidence rate ratio was 1.38: 95% CI (1.27, 1.49) times higher among those married before their 15 birthday, 1.24: 95% CI (1.10, 1.39) times higher among uneducated, 1.95: 95% CI (1.84, 2.06) times higher among those families with large size, 1.67: 95% CI (1.59, 1.76) times higher with child death experience and 1.06: 95% CI (1.01, 1.13) times higher among women living in food-secured households compared to their counterparts. Against other findings, fertility was 1.09: 95% CI (1.04, 1.15) significantly higher among women with no child sex preference. Besides, migration status of women did not seem to predict their fertility levels (1.02: 95% CI (0.97, 1.07)). The contraceptive prevalence rate of 25.4%: 95% CI (24.2, 26.5) in Butajira District was comparable though unmet need of 52.4%: 95% CI (51.1, 53.7) was very high compared to national and regional estimates. Full stock out and absence of methods’ mix, religion, complaints related to providers and methods, assumption of having proper diet, and optimum workload when using family planning methods were barriers of contraceptive use mentioned by study women in the area. The odds of contraception was 2.3: 95% CI (1.66, 3.18) times higher among urbanites, 1.99: 95% CI (1.38, 2.88) times higher among those completed secondary level of education and 1.5: 95% CI (1.12, 2.01) times higher among women whose partners completed secondary plus level of education, 1.3: 95% CI (1.13, 1.5) times higher among women with no experience of child death, 2.21: (1.8, 2.7) times higher among couples who discussed on contraception and 2.59: 95% CI (2.11, 3.17) times higher among women whose partners’ support family planning use compared to their counterparts. Under-five mortality level of 29 per 1000: 95% CI (27.4, 31.8) in the District recorded over the 22 years of surveillance was low. The difference between infant mortality of 86.6 per 1000: 95% CI (77.4, 96.9) and child mortality of 19.2 per 1000: 95% CI (17.4, 21.3) was higher. Compared to their counterparts, the study also showed 0.85: 95% CI (0.79, 0.80) times lower under-five mortality among female children, 1.14: 95% CI (1.03, 1.25) times higher under five mortality among Muslim and 15.24: 95% CI (13.75, 16.89) times higher among minority Christian families, 1.31: 95% CI (1.04, 1.66) and 2.02: 95% CI (1.58, 2.59) times higher among rural highlanders and rural lowlanders respectively, 1.54: (1.43, 1.67) times higher among families owning oxen, and 1.92: 95% CI (1.66, 2.22) times higher among families owning houses and 2.4: 95% CI (1.89, 2.06) times higher among those living in rented houses and 2.13: 95% CI (1.79, 2.53) times higher in children living in houses roofed with thatched grass, and 1.46: 95% CI (1.26, 1.69) times higher among those living in the neighborhoods located 5-9 kilometers away from Butajira zonal hospital. The study also revealed high out-migration of 3.97 per 100 person years (3.93, 4.01) in the district. The risk of out-migration was 0.94: 95% CI (0.92, 0.96) times lower among females, 1.9: 95% CI (1.85, 1.96), 1.77: 95% CI (1.71, 1.82), 1.55: 95% CI (1.49, 1.62), 1.23: 95% CI (1.17, 1.29) or 2.82: 95% CI (2.66, 2.98), 1.29: 95% CI (1.26, 1.32), 4.71: 95% CI (4.56, 4.87), 1.18: 95% CI (1.15, 1.22), 1.58: 95% CI (1.52, 1.64) and 2.11: 95% (2.04, 2.18) times higher among teenagers, the youth, unmarried, primary school completes or above, Orthodox and minority Christians, urbanites, and those living in rented houses and owned by others compared to their respective counterparts. Some relationship between the three components of population change was also observed. There was statistically significant association between early childhood mortality and fertility (6.07: 95% CI (5.36, 6.87)). However, the association between fertility and migration status was not statistically significant (1.05: 95% CI (0.92, 1.19)). Neither was the association between underfive mortality and migration statistically significant (1.04: 95% CI (0.92, 1.19)). Conclusions and Recommendations Fertility was still high in the study community with high rural urban disparity. The most effective proximate determinant to deduct fertility from its biological maximum level was non-marriage due to disruption of marriage through migration of one of the partners. The contribution of contraception and non-marriage was also important among urbanites and educated women. Postpartum infecundability also significantly reduced fertility from its biological maximum in rural areas and among uneducated women. Abortion had also played an important role in reducing fertility among in-school youth. Delayed marriage, higher education, smaller family size, absence of child death in the family, and living in food-secured households were also significantly associated with small number of children. Besides, fertility was significantly higher among women with no child sex preference. However, migration status of women was not statistically significant. The contraceptive prevalence rate in Butajira District was still low, though unmet need was very high. Barrier to contraception in the area included, stock out and absence of preferred family planning methods, religion, complaints related to providers and methods, assumption of having proper diet, and optimum workload when using family planning methods. Significant predictors of contraception in the district included urban residence, women’s and their partners’ educational status, child death experience, couple’s discussion on contraception, and partners’ support. The magnitude of overall early childhood mortality levels in the district recorded over the 22 years of surveillance, though low compared to the national and regional level was still high. Infant mortality was higher than child mortality in the district. Under-five mortality was significantly higher among male children, families confessing Muslim and non-Orthodox Christian denominations, rural residents, families owning oxen, those having their own houses, families living in rent-free houses, households living in houses with roofs of thatched grass, and families living in neighborhoods located between 5-9 kilometers from the zonal hospital as compared with their counterparts. A high incidence of out-migration was observed in the district with higher level among males, teenagers, the youth, primary and secondary education or above completes, those not in marital unions, Christians, urbanites, and families in rented and owed houses compared to those in owned ones. This study had also showed statistically significant association between early childhood mortality and fertility. The association between fertility and migration was not statistically significant. Neither was the case between early childhood mortality and migration in the study area. We recommend that the ills of fast population growth and its consequences should be intensively informed to the public. Women must be encouraged to sustain the practice of extended breastfeeding. Efforts should also be exerted to increase contraceptive use in rural communities. Besides, in-school youth should be aware of post-abortion complications and youth friendly family planning methods to reduce fertility, maternal mortality and childhood mortality in the community. Longer years of women’s education should be scaled up. Health systems in Butajira District and the capacity of staff should be strengthened. The Government should avail family planning methods with appropriate method mix and increase competence of providers on managing temporary side effects. More rigorous child and maternal health education should be channeled through village-based health extension workers. Household hygiene, antenatal care, immunization and facility based delivery in the district should be scaled up. More efforts should also be exerted to improve the quality of residential houses. An insurance scheme to care for the elderly should be put in place to bring about change in the behavior of families towards small family size. We suggest that local authorities need to facilitate local employment and housing opportunities for retaining young and educated people in their own areas, to safeguard the future well-being of the entire population
  • No Thumbnail Available
    Item
    Knowledge and attitude towards VCT services; among adolescent high school students in Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2005-05) Tassew, Feven; Worku, Alemayehu(PhD)
    A cross sectional descriptive study was conducted in February – March 2005, in senior secondary high schools found in Addis Ababa town. High school students (grade 9-12) were included in the study to determine their perception and attitude towards voluntary counseling and testing (VCT) services. A multi stage sampling method was used, and 819 students were included for the analysis (97% response rate), to fill out a structured and pre tested questionnaire. A qualitative study with focus group discussion (FGD) was also conducted with two groups (male and female) students selected from anti AIDS club members to supplement some findings from the quantitative data. Among the respondents 436 (53.2%) were males and 383 (46.8%) were females; 161 (19.7%) of the respondents have sexual experience, or ever had sex intercourse, i.e. 22.5% of the males and 16.4% of the total females. The majority, 92.1% of them know (have heard) about VCT services from different sources but only 129 (15.8%) of the students had used the services & 41.4% said it is expensive for them; 59.5% and 52.5% of the students suggested for the VCT services to be located in schools and youth clubs respectively, for a better access to adolescents. During the focus group discussion, the students said they have shortage of reference materials about HIV/AIDS at school and that there is lack of support to anti AIDS clubs in and out of the school. 7 In conclusion, it could be worth considering to involve schools, teachers and anti AIDS clubs to extend VCT services and reach adolescents in an effective way.
  • No Thumbnail Available
    Item
    Median Age and Determinants of Sexual Initiation among Youths in North East Ethiopia
    (Addis Abeba Universty, 2008-06) Mazengia, Fekadu; Worku, Alemayehu(PhD)
    Background: The very low level of economic development, widespread poverty, very poor and inadequate health services, etc., make the consequences of youth sexuality much more serious in the Ethiopia than those of the developed countries. It is crucial to understand determinants and the surrounding context of early sexual initiation in a broader context for designing and implementing effective interventions targeting youth. Objectives: The aim of this study therefore is to examine the median age and various paths of the commencement of first sex for rural and urban youths Methods: A comparative cross sectional study was conducted between, March 1st -15th in Dessie town and Dessie Zuria Woreda. To draw a total sample of size 1294 (647 urban and 647 rural) a multistage cluster sampling was used. Then, households were selected by random walk method. All youths in the selected households were the study subjects. To collect quantitative data semi-structured, pretested questionnaire & for qualitative FGD was utilized. Eight Trained data collectors and two supervisors collected the data. After data have bean cleaned & coded entered and analyzed using EPI INFO version 2000 and SPSS for Windows version 15.0. Univariate and multivariate analysis were used. Result: About half, 51.3% of the surveyed youths nearly in equal proportion between rural and urban have ever had sex. The Mean & median age of sexual initiation were 16.8 years (SD= 2.25) and 17 years respectively (Range 8-24 years). Rural youths initiate sex at lower age mean and median (16.49+2.11) and 16.00 than their urban counterparts mean and median (17.18+2.32) and 17.00 respectively the hzard was significant (AHR [95% CI] =1.45 (1.19, 2.55). Multivariate analysis show that female by gender OR [95%CI]=1.56(1.11,2.19), chew Khat (adj. OR [CI] = 2.05 [1.05–3.96]),who drink alcohol (adj OR [CI] = 2.05 [1.05– 3.96),who viewed pornographic materials < 18 years Adj OR= 24.133 (3.28, 177.80) and less connected with parents adj. 0R=2.30(1.35, 3.91)were more likely to have early sexual initiation. Nearly two third of the sexual initiations were unprotected and some occur with higher risk groups. Half of the sexually active youths have >2 sexual partner in there life time. Furthermore, 14% out of which had sex with a non-regular (causal) sexual partner. Attributed to their early and unprotected sexual initiation a significant number of adolescents face the untoward complication of early sexual initiation. Of the sexually active youths 13% 9 report STI 45% of female were pregnant at least once in there sexual life time. Logistic analysis to see the impact of early sexual initiation showed that early initiators were more likely to be exposed to STIs & multiple partnership than late initiators [adj OR 95%CI] =2.08(1.17, 3.72) and [adj OR (95%CI) = 2.33(1.61, 3.37)] respectively. Conclusion and Recommendation: Early sexual initiation was prevalent and mostly unexpected and unprotected. Those who initiate early were more likely to have bad reproductive outcomes and risky behaviours like multiple partnership, STIs, unwanted pregnancy and probably HIV. In all aspects the problem prevails in rural youths than urban. Delaying sexual debate is the pillar of HIV & other STIs prevention among youths. This can be achieved through starting well designed sexual education programs at earlier life. Strengthening the norm of virginity is should be advocated & equally ways to access condoms and other contraceptives specially to rural youths should be sought.
  • No Thumbnail Available
    Item
    Predictors of late HIV Diagnosis Among People living with HIV in Adare and Yirgalem General Hospitals, SNNPR, Ethiopia: a Case Control Study
    (Addis Abeba Universty, 2014-07) Alemayehu, Akalewold; Worku, Alemayehu(PhD)
    Introduction: Even if early diagnosis, access to treatment and ensuring people living with HIV to receive ongoing care and treatment is one of the most effective ways to prevent the further spread of HIV and to protect the health of those living with the virus, lack of knowledge of HIV status is a major barrier to HIV prevention, care and treatment efforts. This is because; the majorities of people with HIV who do not know they are infected, for a variety of reasons, came late for diagnosis and lately linked for care resulting in different negative outcomes. Objective: The objective of this study was to identify predictors for late HIV diagnosis among people living with HIV in Adare and Yirgalem general hospitals, SNNPR, Ethiopia. Method: Facility based unmatched case-control study design was used in the study and a total sample size of 438 (216 cases and 222 controls) were recruited from clients who were visiting the ART clinics of Adare hospitals and Yirgalem general Hospital from 10th February to 16th April, 2014. Cases were HIV positive individuals who have a CD4 cell count of <350/μl regardless of the clinical staging or WHO clinical stage III or IV regardless of their CD4 cell count at the time of diagnosis., while controls were HIV positive individuals who have CD4 cell count of >350/μl and WHO clinical stage I or II at the time diagnosis. Data was collected by trained ART clinic nurses of the respective hospitals through card review and face to face interview. Binary logistic regression and multiple logistic regression analysis were carried out to identify predictors of late HIV diagnosis. Data were presented using frequencies, percentages, odds ratio with 95% confidence interval. Results: Among the study participants 117 (54.2%) of cases and 71 (32.0%) of controls were males and with the mean and standard deviation of age 31.87+7.94 years among cases and 28.92+7.27 years among controls. Males, (Adjusted OR= 1.869, 95 % CI 1.159, 3.015) , older age (> 40 years), (Adjusted OR= 2.681, 95 % CI 1.203, 5.973), tested for illness/symptom, (Adjusted OR= 2.019, 95 % CI 1.091, 3.735) and opportunistic illness at diagnosis (Adjusted OR= 2.249, 95 % CI 1.448, 3.496) were independent predictors for late HIV diagnosis; whereas having lifetime sexual partner six and above (> 6) was associated with early presentation for diagnosis (Adjusted OR= 0.213, 95 % CI 0.068, 0.668). VIII Conclusion and recommendation: Males, old age, testing due to symptom and opportunistic infection at diagnosis were independent predictors of late HIV diagnosis, whereas having lifetime sexual partner six and above have protective effect. The HIV prevention and control efforts and HIV testing programs should target males as well as older age groups and promoting routine HIV testing as part of regular medical care may contribute to the reduction of late HIV diagnosis. Further large scale study should be done including patients not attending ART clinic and clients visiting health facility with unknown HIV status