Public Health (PhD)

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Browsing Public Health (PhD) by Subject "Addis Ababa"

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    Burden and Risk Factors of Hypertension, Diabetes Mellitus and Dyslipidemia among Adults in Addis Ababa, Ethiopia: a Community Based Study
    (Addis Ababa University, 2025-05) Asemu,Meseret Molla; Worku,Alemayehu(PHD); Deyessa,Negussie(PHD); Mekonnen,Desalew(MD)
    Background: Non-Communicable Diseases (NCDs) are the leading cause of illness worldwide, disproportionately affecting Low and Middle Income Countries (LMICs), accounting for more than four-fifths of premature deaths every year. The African continent experiences a high burden of NCDs, mainly cardiovascular diseases (heart disease and stroke), cancer, diabetes, chronic respiratory diseases, and poor mental health. Alike most LMICs across the world, Sub-Saharan African countries are undergoing a rapid epidemiological transition characterized by a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles dominated by chronic non-communicable diseases. In Ethiopia, especially in the study area, few studies have been done on the epidemiology of NCDs, like HTN, diabetes and dyslipidemia. Therefore, we sought to evaluate the epidemiology of HTN (HTN), Diabetes Mellitus (DM) and dyslipidemia among adult populations of Addis Ababa Ethiopia. Objective: To describe the prevalence and associated risk factors of HTN, diabetes, and dyslipidemia among adults living in Addis Ababa, Ethiopia. Methods: Between June and October of 2018, the study was carried out in Ethiopia's capital city of Addis Ababa. For all three papers (paper I, II, and III), a community-based cross-sectional study design was used to collect data on the prevalence and related variables of non-communicable diseases (HTN, diabetes, and dyslipidemia). The source population consisted of adults who were at least 18 years old. A multi-stage cluster sampling technique was used. A total of 3724 participants were recruited to work on objective 1, while 692 participants were recruited to work on objectives 2 and 3. All the three World Health Organization STEPwise approach to Non-Communicable Diseases risk factor surveillance were used. The investigator hired phlebotomists with prior experience in data collection and health professionals with a Bachelor of Science degree to collect data. A face-to-face interview was conducted, followed by physical measurements and the collection of a blood sample the next day. The statistical program EpiData 3.1 was used for double data entry operations, and SPSS version 23 was used for analysis. Logistic regression, both bivariate and multivariable, was used. Results: In all, 3560 people aged 18 to 91 took part in objective 1, representing a 95.6% response rate. Most people (42.4%) were between the ages of 18 and 29, with the median age being 32 (IQR 25, 45). Women made up the majority of responders (57.3%), whereas 602 and 582 people participated in objectives 2 and 3, respectively. The percentages of people with HTN, diabetes mellitus, and dyslipidemia, were, 29.2% (95% CI: 27.7–30.7), 14.3% (95% CI: 11.5–17.1), and 77.3% (95% CI: 73.9–80.7) respectively. Among the respondents, 61.9% of hypertensive cases, 70.9% of diabetes cases, and 96.2% of dyslipidemia cases had been newly diagnosed at the time of the survey. The following factors were found to be significantly associated with HTN: being male (AOR = 1.9, 95% CI: 1.2–2.9), eating vegetables ≤ three days a week (AOR = 2.4, 95% CI: 1.2–4.9), drinking coffee more than two cups per day (AOR = 0.5, 95% CI: 0.3-0.8), being obese (AOR = 2.05, 95% CI: 1.1–3.7), and being in the age groups 30–49 and ≥ 50 years (AOR = 2.8, 95% CI: 1.4–5.6) and 8.23, 95% CI: 4.1–16.6), respectively. While hypertriglyceridemia (AOR= 1.9, 95% CI: 1.2–3.4), low HDL-C level (AOR= 2.7, 95% CI: 1.6–4.7), obesity (AOR= 4.6, 95% CI: 2.2–9.3), overweight (AOR= 2.3, 95% CI: 1.2–4.2), and age 50 years and above (AOR= 3.9, 95% CI: 1.6–9.5) were significantly associated with diabetes mellitus. Furthermore, factors associated with triglyceridemia included being female (AOR=0.6, 95% CI: 0.4-0.9), aged 30-49 and ≥50 years (AOR= 2.7, 95% CI: 1.6-4.6) and 2.3, 95% CI: 1.3-4.0) respectively, having diabetes mellitus (AOR= 2.1, 95% CI: 1.3-3.4), sitting for more than three hours a day (AOR=1.6, 95% CI: 1.0-2.4), and having HTN (AOR= 2.3, 95% CI: 1.6-3.3); factors associated with low HDL-C were being female (AOR=2.1, 95% CI: 1.4-3.3), obese (AOR=1.9, 95% CI: 1.2-3.4), and having diabetes mellitus (AOR= 2.3, 95% CI: 1.4-3.8); factors associated with cholesterolemia were being female (AOR= 1.6, 95% CI: 1.0-2.4), being in the age groups 30–49 and ≥ 50 years (AOR= 5.2, 95% CI: 2.7-10.3) and 6.4, 95% CI: 3.2-13.0), respectively, and having HTN (AOR=1.6, 95% CI: 1.1-2.3); moreover, factors associated with high LDL- C were being in the age groups 30–49 and ≥ 50 years (AOR = 8.4, 95% CI: 2.9-24.0) and 8.5, 95% CI: 2.9-24.8), respectively, and being hypertensive (AOR=1.7, 95% CI: 1.1-2.7). Conclusions and Recommendation: In Addis Ababa, one in three people has HTN, and one in seven has diabetes mellitus. Furthermore, a significant portion of the study subjects had dyslipidemia. Many of the individuals were not aware that they had HTN, diabetes, or dyslipidemia. The factors associated with HTN included age, obesity, eating less vegetable, coffee drinking (protective), and being a man. Age, obesity, overweight, low HDL-C, and triglyceridemia were the risk factors for diabetes mellitus. In addition, factors linked to dyslipidemia included sex, age, and obesity, HTN, sitting for longer than three hours a day, and diabetes mellitus. Moreover, diabetes mellitus is a disorder that is associated with dyslipidemia and vice versa. Furthermore, HTN and diabetes mellitus are risk factors for dyslipidemia. Advanced age and obesity were significant risk factors for hypertension, diabetes, and dyslipidemia. The Ministry of Health must take a comprehensive approach in order to support programs for the prevention and control of NCDs and lower the risks related to them. It is also advised that health facilities expand their ability to provide NCDs-related services, such as screening. In order to track and evaluate changes in the burden of NCDs over time, strategies for community surveillance programs and intervention measures that address modifiable risk factors must also be developed. Community-level encouragement should also be given to selective screening programs and intervention strategies that focus on modifiable risk factors. The mass media should play a role in the behavioral change of the community towards early screening, discouraging smoking, khat chewing, and alcohol consumption.
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    Effect of Anteritroviral Therapy(ART) on Fertility Intentions and Contraceptive Prefernce of HIV Positive Women in Addis Ababa, Ethiopia
    (Addis Ababa University, 2015-05) Mekonnen,Hussen; Gashe,Fikre Enquselassie(BSc,MSc,PhD)
    Background: The advent of antiretroviral therapy (ART) has improved quality of life and survival for people living with HIV (PLWH) and now days HIV infection can be seen as a chronic manageable disease, as a result many will contemplate child bearing. Although, ART has influence in improving quality of life and reduce mother to child transmission of HIV virus (MTCT) in developed countries, vertical transmission accounts for more than 90% of pediatric AIDS in prevalent areas, as a result, reproductive assistance to HIV positive women is important to have informed decision making about child bearing and child rearing. In Ethiopia, while anti-retroviral therapy (ART) services are increasingly available, information about fertility intentions, contraceptive use and method preference among women living with HIV in relation to ART use is scarce. Moreover, change in fertility intentions 12 months after ART intiation and reasons in selection of those options are lacking. Those factors raise concern on possible exposure of many HIV positive women to the potential risk of unintended pregnancy and hinder them from seeking options. Objectives: the purpose of the study was to assess effect of ART on the fertility intentions and contraceptive use and method preference of HIV positive women in Addis Ababa, Ethiopia. Methodology: Health facility based cross sectional quantitative and qualitative studies including follow up studies were conducted. For the quantitative part, a total of 1855 HIV positive women aged 15-49 years for cross sectional survey and 360 HIV positive women participated for the follow up study. Focus group discussion, in depth interviews and key informant interviews were done for the qualitative part. Data were collected from June 2012 to December 2013 using validated structured questionnaires for quantitative and semi structured questionnaires for qualitative part. Data were double entered in to epidemiological software (Epi Info version 3.5.1). Descriptive statistics, bivareate and multivariate statistical analysis were done using SPSS version 20 soft ware. Results: Overall, 44% of women reported childbearing intention and 71% women reported using contraception 75% (n=579) ART users and 65% (n=422) ART naïve women. Male condom and injectables were the most preferred contraceptive methods among both groups. The proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated 55.5% (n=106) than ART naïve 40% (n=68) women. The presence of ART, improvement of health condition and the influence of husband, family, community and associated stigma were the main reasons for childbearing intentions of women in the study area. In adjusted logistic regression analysis, ART users had higher fertility intention (AOR; 1.26, 95%CI; 1.01 to 1.60) than ART naïve. Furthermore, being in a sexual relationship, young age, being single and having fewer or no children were found to be predictors of fertility intentions. Women receiving ART reported more use of contraceptives (AOR 1.60, 95% CI, 1.30- 2.12) than ART naïve women. In addition to this, presence of partner (AOR 2.32, 95% CI, 1.60-3.40), disclosure of HIV status to husband (AOR 2.23, 95 % CI, 1.21-4.12), presence of living children: one (AOR 1.7, 95% C I, 1.03-2.40), two (AOR 2.6, 95% CI, 1.7-4.02) and three (AOR 3.3, 95% CI, 1.90-5.60) respectively were found to be predictors of contraceptive use among HIV positive women. Overall, 41.0 % (147/360) of the women reported fertility intentions at the baseline, while 48.3 %( 174/360) reported fertility intentions 12 months after follow up. The proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated 55.8% (106/190) than HAART naïve 40% (68/170) women. Furthermore, the need for more children 12 months after ART initiation was significantly associated with woman’s ART use (AOR, 2.46, 95%CI, 1.20-5.20). Single and married women (AOR, 5.32, 95%CI, 1.10-25.92) (AOR: 6.34, 95%CI, 1.43-27.99) respectively, were more likely to report fertility intention than divorced/ widowed women. Women who had at least one child (AOR, 0.32, 95% CI, 0.13-0.85) were less likely to change fertility intentions compared to women with no children. Conclusions: Fertility intentions are common among HIV positive women and change in intention for a child starts soon after initiation of ART. About three in four HIV positive women use contraceptive methods mainly condoms. Dual contraceptive method use was negligible among the study subjects. Fertility and contraceptive decisions of women are influenced by presence of ART, partner desire, family and community perception and associated stigma. Many participants indicated that health service providers are supportive in offering information more on preventive methods rather than discussing fertility and contraceptive options. Recommendations: It is necessary to strengthen an integrated sexual and reproductive health (SRH) service and HIV prevention, ART services to address the diverse SRH needs of HIV positive women in the study area. Furthermore, updating health care providers with fertility and contraceptive knowledge is valuable to enhance family planning and preventive practice of women.