Addressing the Impact of Noncommunicable Diseases and Injuries (NCDIs) in Ethiopia: Findings and Recommendations from the Ethiopia NCDI Commission.

BACKGROUND: Noncommunicable diseases and injuries (NCDIs) are the leading causes of premature mortality globally. Ethiopia is experiencing a rapid increase in NCDI burden. The Ethiopia NCDI Commission aimed to determine the burden of NCDIs, prioritize health sector interventions for NCDIs and estimate the cost and available fiscal-space for NCDI interventions. METHODS: We retrieved data on NCDI disease burden and concomitant risk factors from the Global Burden of Disease (GBD) Study, complemented by systematic review of published literature from Ethiopia. Cost-effective interventions were identified through a structured priority-setting process and costed using the One Health tool. We conducted fiscal-space analysis to identify an affordable package of NCDI services in Ethiopia. RESULTS: We find that there is a large and diverse NCDI disease burden and their risk factors such as hypertension and diabetes (these conditions are NCDIs themselves and could be risk factors to other NCDIs), including less common but more severe NCDIs such as rheumatic heart disease and cancers in women. Mental, neurological, chronic respiratory and surgical conditions also contribute to a substantial proportion of NCDI disease burden in Ethiopia. Among an initial list of 235 interventions, the commission recommended 90 top-priority NCDI interventions (including essential surgery) for implementation. The additional annual cost for scaling up of these interventions was estimated at US$550m (about US$4.7 per capita). CONCLUSIONS: A targeted investment in cost-effective interventions could result in substantial reduction in premature mortality and may be within the projected fiscal space of Ethiopia. Innovative financing mechanisms, multi-sectoral governance, regional implementation, and an integrated service delivery approach mainly using primary health care are required to achieve these goals.

Home-based HPV self-sampling assisted by a cloud-based electronic data system: Lessons learnt from a pilot community cervical cancer screening campaign in rural Ethiopia.

Primary HPV testing and triage of HPV-positive women is an effective cervical cancer screening strategy. Such a multi-visit screening algorithm is also promising for community-based screening in resource-poor communities, provided a robust tracking system is in place. A cervical cancer screening campaign was conducted in a rural community in Ethiopia. All women aged 25-65 years were offered genital self-sampling using the Evalyn Brush®. Samples were HPV-DNA-tested at a central laboratory. Key indicators were captured on tablet computers and linked by a cloud-based information system. HPV-positive women were examined at the local clinic using portable colposcopy, p16/Ki-67 dual stain cytology and biopsy examination. CIN2+ women were referred for LEEP to the referral hospital. Of 749 enumerated age-eligible women 634 (85%, (95% CI 82-88)) consented to screening, 429 samples were adequate for HPV testing, giving a total testing coverage of 57% (95% CI 53-62). The hrHPV prevalence was 14% (95% CI 5-22), 72% (95% CI 60-84) attended the clinic for a triage examination. Home-based HPV-DNA self-sampling and clinic-based triage assisted by cloud-based information technology is feasible in rural Ethiopia. Key components of such strategy are broad community awareness, high competency of community workers, and establishment of an adequate self-sampling and HPV-DNA testing platform.

Exclusive breastfeeding and rotavirus vaccination are associated with decreased diarrheal morbidity among under-five children in Bahir Dar, northwest Ethiopia.

BACKGROUND: More than one in every ten (14%) of under-five child deaths is associated with diarrheal morbidity in Ethiopia. Although Ethiopia has implemented different health interventions like its immunization program, childhood diarrhea morbidity, on which literature is limited, continues as a public health problem. Hence, the aim of this study was to assess the prevalence of diarrheal morbidity and associated factors among under-five children in Bahir Dar, northwest Ethiopia. METHOD: A community based cross-sectional study was carried out from March 05 to April 03/2015 in Bahir Dar in which 553 mother-child pairs participated. A structured questionnaire was adapted from the World Health Organization (WHO) and the Ethiopian Demography and Health Survey (EDHS) to collect the data. Bivariate and multivariate logistic regression analyses were carried out to identify the independent predictors of diarrheal morbidity. RESULT: The overall prevalence of diarrheal morbidity was 9.4% [95% Confidence Interval (CI): 4.8, 14.0%]. No receipt of Rotavirus vaccine dose 2 [AOR = 3.96, 95%CI; 2.13, 7.33], non-exclusive breastfeeding [AOR = 2.69, 95%CI; 1.39, 5.19], unavailability of solid waste disposal system [AOR = 2.62, 95%CI; 1.19, 5.77], employed and private business occupational status of mothers [AOR = 2.10, 95%CI; 1.02, 4.31)], and less than Ethiopia Birr (ETB) 600 household monthly income [AOR = 2.10, 95% CI; 1.2, 7.2] were independently associated with diarrheal morbidity. CONCLUSION: In Bahir Dar, one in every ten of the under-five children surveyed suffered from diarrheal morbidity. Thus, implementing effective rotavirus vaccination programs, encouraging exclusive breastfeeding and emphasizing appropriate solid waste management would reduce childhood diarrheal morbidity in the region. In addition, the finding suggests that improved child care mechanisms, especially for mothers working outside the home, and efforts to increase household income should be intensified to reduce incidence of diarrhea.

National disability-adjusted life years (DALYs) for 257 diseases and injuries in Ethiopia, 1990-2015: findings from the global burden of disease study 2015.

BACKGROUND: Disability-adjusted life years (DALYs) provide a summary measure of health and can be a critical input to guide health systems, investments, and priority-setting in Ethiopia. We aimed to determine the leading causes of premature mortality and disability using DALYs and describe the relative burden of disease and injuries in Ethiopia. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for non-fatal disease burden, cause-specific mortality, and all-cause mortality to derive age-standardized DALYs by sex for Ethiopia for each year. We calculated DALYs by summing years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) for each age group and sex. Causes of death by age, sex, and year were measured mainly using Causes of Death Ensemble modeling. To estimate YLDs, a Bayesian meta-regression method was used. We reported DALY rates per 100,000 for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases, and injuries, with 95% uncertainty intervals (UI) for Ethiopia. RESULTS: Non-communicable diseases caused 23,118.1 (95% UI, 17,124.4-30,579.6), CMNN disorders resulted in 20,200.7 (95% UI, 16,532.2-24,917.9), and injuries caused 3781 (95% UI, 2642.9-5500.6) age-standardized DALYs per 100,000 in Ethiopia in 2015. Lower respiratory infections, diarrheal diseases, and tuberculosis were the top three leading causes of DALYs in 2015, accounting for 2998 (95% UI, 2173.7-4029), 2592.5 (95% UI, 1850.7-3495.1), and 2562.9 (95% UI, 1466.1-4220.7) DALYs per 100,000, respectively. Ischemic heart disease and cerebrovascular disease were the fourth and fifth leading causes of age-standardized DALYs, with rates of 2535.7 (95% UI, 1603.7-3843.2) and 2159.9 (95% UI, 1369.7-3216.3) per 100,000, respectively. The following causes showed a reduction of 60% or more over the last 25 years: lower respiratory infections, diarrheal diseases, tuberculosis, neonatal encephalopathy, preterm birth complications, meningitis, malaria, protein-energy malnutrition, iron-deficiency anemia, measles, war and legal intervention, and maternal hemorrhage. CONCLUSIONS: Ethiopia has been successful in reducing age-standardized DALYs related to most communicable, maternal, neonatal, and nutritional deficiency diseases in the last 25 years, causing a major ranking shift to types of non-communicable disease. Lower respiratory infections, diarrheal disease, and tuberculosis continue to be leading causes of premature death, despite major declines in burden. Non-communicable diseases also showed reductions as premature mortality declined; however, disability outcomes for these causes did not show declines. Recently developed non-communicable disease strategies may need to be amended to focus on cardiovascular diseases, cancer, diabetes, and major depressive disorders. Increasing trends of disabilities due to neonatal encephalopathy, preterm birth complications, and neonatal disorders should be emphasized in the national newborn survival strategy. Generating quality data should be a priority through the development of new initiatives such as vital events registration, surveillance programs, and surveys to address gaps in data. Measuring disease burden at subnational regional state levels and identifying variations with urban and rural population health should be conducted to support health policy in Ethiopia.

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

BACKGROUND: Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. METHODS: GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. RESULTS: CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. CONCLUSIONS: Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

Patients' Delay in Seeking Health Care for Tuberculosis Diagnosis in East Gojjam Zone, Northwest Ethiopia.

AbstractPatients' delay in seeking diagnosis is a major problem in the management of tuberculosis (TB). Relative to the burden of TB, there is lack of data on the magnitude of delays in seeking care and why patients fail to seek early care at health facilities in Ethiopia. A facility-based cross-sectional study was conducted from April to July 2013 in East Gojjam Zone, Amhara, Ethiopia, to assess patients' delays and associated factors in TB patients. Using simple random sampling, 605 (327 male and 278 female) participants were recruited. Of the total, 323 (53.4%) TB patients were delayed in seeking health care (median = 45 days; mean = 78.5 days). The following independent variables were associated with patient delays: age ≥ 45 years (adjusted odds ratio [AOR] = 8.74, 95% confidence interval [CI] = 4.71-16.23, P < 0.001); working as a farmer (AOR = 4.18, 95% CI = 1.44-12.11, P = 0.009); prior visit to holy water sites, traditional healers, and/or private drug shops (AOR = 69.11, 95% CI =13.91-343.29, P < 0.001; AOR = 14.74, 95% CI = 1.43-152.31, P = 0.024; AOR = 2.10, 95% CI = 1.22-3.59, P = 0.007, respectively); poor knowledge about TB (AOR = 2.79, 95% CI = 1.74-4.92, P = 0.006), and extrapulmonary TB (AOR = 14.69, 95% CI = 8.21-26.26, P < 0.001). Generally, patients' delay in seeking care at health facilities was high (53.4%). Most of TB patients getting treatment from holy water (95.3%; 101/106) and traditional healers (84.6%; 11/13) were delayed. Therefore, for early seeking in modern health care, a combination of interventions is required to encourage TB patients.

Risk Factors of Overweight and Obesity among High School Students in Bahir Dar City, North West Ethiopia: School Based Cross-Sectional Study.

Background. Overweight and obesity are risk factors for diet-related noncommunicable diseases. These diseases are the fifth leading risks for global deaths. Virtually, all age groups are affected from consequences of overweight and obesity. Methods. Cross-sectional study was conducted among 431 school adolescents. Data were collected using self-administered questionnaire and physical measurements. The sex and age specific BMI was computed using WHO Anthroplus software and the data were analyzed using bivariate and multivariable logistic regression analysis. Results. The magnitudes of overweight and obesity were 12.3% and 4.4%, respectively, and the combined prevalence of overweight and obesity together was 16.7%. Three-fourths of the respondents (74.7%) had healthy body mass index; however, 8.6% were underweight. Sex, frequency of eating food out of home, school type, family monthly income, family having vehicle, vigorous physical activity, and frequency of vigorous physical activity were statistically significant predictors of overweight and obesity. Conclusion. The problems of overweight and obesity are taking place while students are still under the risk of underweight. Several factors were correlated with overweight and obesity. Therefore, interventions targeting gender, frequency of eating food out of home, vigorous activities, and frequency of doing vigorous physical activity are recommended.

Prevalence and associated factors of active trachoma among childeren aged 1-9 years in rural communities of Gonji Kolella district, West Gojjam zone, North West Ethiopia.

BACKGROUND: Trachoma is the leading infectious cause of blindness worldwide. Though trachoma can be treated with antibiotic it is still endemic in most part of Ethiopia. METHODS: A community based cross-sectional study was conducted among 618 children 1-9 years of age from December 2013 to June 2014. A multistage systematic sampling technique was applied. Data were collected using pretested and structured questionnaire and also observation by using binocular loupe to differentiate active trachoma cases. The World Health Organization's simplified classification scheme for assessing trachoma in community based surveys was used for the purpose. Bivariate and multivariate logistic regression model was fitted to identify factors associated with trachoma among children aged 1-9 years. An adjusted odds ratio with 95 % confidence interval was computed to determine the level of significance. RESULTS: The overall prevalence of active trachoma among children aged 1-9 years were 23.1 % (Trachomatous inflammation-Follicular, in 22.5 % (95 % CI: 22.3-22.69 %); Trachomatous inflammation-Intense, in 0.6 % (95 % CI: 0.4-0.79 %). Family size (>5) (AOR = 14.32, 95 % CI = 6.108-33.601), number of children under 10 years of age within household (AOR = 25.53, 95 % CI = 9.774-66.686), latrine utilizations (AOR = 10.274, 95 % CI = 4.274-24.968), route of waste disposal (AOR = 3.717, 95 % CI = 1.538 to -8.981), household literacy (AOR = 2.892, 95 % CI = 1.447-5.780), cattle housing practice (AOR = 4.75, 95 % CI = 1.815-12.431), time to collect water (AOR = 25.530, 95 % CI = 8.995-72.461), frequency of face washing practice (AOR = 6.384, 95 % CI = 2.860-14.251) and source of water (AOR = 2.353, 95 % CI = 1.134-4.882) were found to be associated with the presence of active trachoma in this study population. CONCLUSION: The prevalence of active trachoma among rural communities of children aged 1-9 years was found to be high in reference to WHO recommended thresholds to initiate trachoma control recommendation (>10 % prevalence), which indicates that active trachoma is still a major public health concern in the study area. Therefore, it is recommended that coordinated work on implementing the WHO endorsed SAFE strategy in particular and enhancing the overall living conditions of the community is crucial.

Level of male involvement and associated factors in family planning services utilization among married men in Debremarkos town, Northwest Ethiopia.

BACKGROUND: Men's participation is crucial to the success of family planning programs and women's empowerment and associated with better outcomes in reproductive health such as contraceptive acceptance and continuation, and safer sexual behaviors. Limited choice and access to methods, attitudes of men towards family planning, perceived fear of side-effects, poor quality of available services, cultural or religious oppositions and gender-based barriers are some of the reasons for low utilization of family planning. Hence, this study assessed the level of male involvement in family planning services utilization and its associated factors in Debremarkos town, Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from October to November, 2013. Multi-stage sampling technique was used to select 524 eligible samples. Data were collected by using semi-structured questionnaires. Epi Info and SPSS were used to enter and analyze the data; univariate, bivariate and logistic regression analyses were performed to display the outputs. RESULTS: Only 44 (8.4%) respondents were using or directly participating in the use of family planning services mainly male condoms. The reasons mentioned for the low participation were the desire to have more children, wife or partner refusal, fear of side effects, religious prohibition, lack of awareness about contraceptives and the thinking that it is the only issue for women. Opinion about family planning services, men approval and current use of family planning methods were associated with male involvement in the services utilization. CONCLUSIONS: In this study, the level of male involvement was low. Lack of information, inaccessibility to the services and the desire to have more children were found to be the reasons for low male involvement in family planning services utilization. Governmental and nongovernmental organizations, donors and relevant stakeholders should ensure availability, accessibility and sustained advocacy for use of family planning services. The family planning programs should incorporate the responsibility and role of males in the uptake of family planning services.

Risk of HIV and associated factors among infants born to HIV positive women in Amhara region, Ethiopia: a facility based retrospective study.

BACKGROUND: The estimated HIV prevalence among pregnant women in Ethiopia is 1.2 percent and unfortunately one of every 3 children born to these women gets infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of the pregnant women living with HIV have yet received the medication needed to prevent the transmission of HIV. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers is increasing. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV, in South Gondar zone, Amhara region, Ethiopia. METHODS: Facility based document review was conducted upon 434 charts. The study participants were HIV exposed infants enrolled from January to December 2012. The data were reviewed from all the 17 health facilities which were providing PMTCT services in the zone. The study included 434 HIV exposed infants having an HIV Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) test result. The data were collected using structured data extraction tool. Binary logistic regression analysis was employed to assess the putative association of independent variables with the outcome variable. Significance was taken at a P value<0.05 and 95% confidence level. RESULT: The prevalence of HIV among HIV exposed infants was 10.1% (95% CI=7.3-13%). Delayed diagnosis (AOR=2.7, 95% CI=1.3, 29.4), mixed infant feeding (AOR=8.8, 95% CI=4.5, 22.8), failure to receive either antiretroviral therapy or prophylaxis during pregnancy or breast feeding (AOR=21.6, 95% CI=14.5, 39.8) and shorter duration of HIV treatment (AOR=12, 95% CI=(4.2, 45.0) were the factors that increase the risk of mother- to- child transmission of HIV. CONCLUSION: The prevalence of HIV infection among HIV exposed infants is strikingly high. Inadequate use of antiretroviral therapy and skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Integrated and audience specific education and promotion for seeking obstetric care and HIV services is instrumental to curb the devastating consequences of HIV on pregnant women and their newborns.

Current level and correlates of traditional cooking energy sources utilization in urban settings in the context of climate change and health, northwest Ethiopia: a case of Debre Markos town.

BACKGROUND: Traditional biomass has been the major source of cooking energy for major segment of Ethiopian population for thousands of years. Cognizant of this energy poverty, the Government of Ethiopia has been spending huge sum of money to increase hydroelectric power generating stations. OBJECTIVE: To assess current levels and correlates of traditional cooking energy sources utilization. METHODS: A community based cross-sectional study was conducted employing both quantitative and qualitative approaches on systematically selected 423 households for quantitative and purposively selected 20 people for qualitative parts. SPSS version 16 for windows was used to analyze the quantitative data. Logistic regression was fitted to assess possible associations and its strength was measured using odds ratio at 95% CI. Qualitative data were analyzed thematically. RESULT: The study indicated that 95% of households still use traditional biomass for cooking. Those who were less knowledgeable about negative health and environmental effects of traditional cooking energy sources were seven and six times more likely to utilize them compared with those who were knowledgeable (AOR (95% CI) = 7.56 (1.635, 34.926), AOR (95% CI) = 6.68 (1.80, 24.385), resp.). The most outstanding finding of this study was that people use traditional energy for cooking mainly due to lack of the knowledge and their beliefs about food prepared using traditional energy. That means "...people still believe that food cooked with charcoal is believed to taste delicious than cooked with other means." CONCLUSION: The majority of households use traditional biomass for cooking due to lack of knowledge and belief. Therefore, mechanisms should be designed to promote electric energy and to teach the public about health effects of traditional cooking energy source.

The status of iodine nutrition and iodine deficiency disorders among school children in Metekel Zone, northwest Ethiopia.

BACKGROUND: Iodine deficiency disorders are serious public health problems in Ethiopia. The aim of this study was to measure the prevalence and severity of iodine deficiency disorders among school children in Metekel Zone. METHODS: A cross-sectional school based descriptive study was conducted between February 2011 and July 2012. One school containing 750 children aged between 6 and 18 years was randomly selected. Two hundred students from this school were selected by systematic random sampling. Physical examination was made according to WHO goiter classification system; 50 salt samples from households to which the sampled children belonged were tested for iodine using rapid field test kits and titration; a casual urine sample (5 ml) was taken from 30 children to measure urinary iodine spectrophotometrically, and 5 ml venous blood sample were collected from 37 children to measure thyroid relevant blood constituents using ELISA. RESULTS: The total goiter prevalence was 39.5%; 60% of the salt samples contained no iodine. The median urinary iodine concentration ranged from 20.54 - 62.2 (39.9 µg/L). School children who were assessed for thyroid hormones showed 18.92% elevated and 27.03% suppressed TSH levels. CONCLUSION: The study demonstrated that iodine deficiency is still a severe public health problem in Metekel Zone. There is a need to further strengthen the existing controlling and monitoring system in order to achieve proper elimination of IDDs in the community.

Podoconiosis patients' willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery.

BACKGROUND: Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient's willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. METHODS: A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n=393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. RESULTS: The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. CONCLUSIONS: The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government's primary health care system.

Epidemiology of human fascioliasis and intestinal parasitosis among schoolchildren in Lake Tana Basin, northwest Ethiopia.

BACKGROUND: Parasitic diseases are the second most frequent cause of outpatient morbidity in Ethiopia. METHODS: A cross-sectional study was conducted in Lake Tana Basin, northwest Ethiopia, from November 2007 to February 2008, to assess the magnitude and associated risk factors for parasitic diseases, including human fascioliasis. We examined 520 stool samples from randomly selected schoolchildren in six schools by microscopy. Rapid sedimentation and Kato-Katz techniques were used to detect and count Fasciola and Schistosoma eggs. The formol-ether concentration method was used for the identification of other helminth eggs, larvae and cysts of protozoan parasites. RESULTS: The overall prevalence of intestinal parasitic infections was 71.3% (95% CI 67.3-75.1%). Hookworm was the predominant intestinal parasite (23.5%, 95% CI 19.8-27.1%), followed by Ascaris lumbricoides (18.5%, 95% CI 15.2-21.9%) and Schistosoma mansoni (16.7%, 95% CI 13.5-19.9%). One hundred and sixty-three (31.4%) children had multiple parasitic infections. The most relevant finding was a prevalence of Fasciola spp. of 3.3% in an area where only sporadic cases have been reported previously. The risk of Fasciola spp. infection was significantly associated with raw vegetable consumption, use of unsafe drinking water sources, irrigation practices and sheep and/or cattle ownership. Irrigation practices, male gender, raw vegetable consumption and use of unsafe drinking water sources were risk factors for S. mansoni infection. CONCLUSIONS: A high prevalence of parasitic infections among children in the region was found, including a relatively high prevalence of Fasciola spp. infection. Epidemiological studies on the magnitude of parasitic infections in different regions will enable high-risk communities to be identified and allow for planning of appropriate interventions.

Diarrhoea-associated parasites in HIV-1 seropositive and sero-negative patients in a teaching hospital, Northwest Ethiopia.

OBJECTIVE: to determine the prevalence and type of intestinal parasites in HIV infected and uninfected patients with diarrhea. DESIGN: A cross-sectional study was conducted at Gondar University hospital, Northwest Ethiopia, between March 2003 and October 2004. PATIENTS AND METHODS: A total 312 consecutive diarrheic patients were included in the study. Stool specimens were collected and examined for intestinal parasites following direct, formol-ether concentration and modified acid fast staining methods. RESULTS: Among the patients, 63.8% were found to be HIV seropositive. The prevalence of intestinal parasites in HIV seropositive and seronegative diarrheic patients was 30.6% and 33.6%, respectively. The most prevalent parasites were Strongyoides stercoralis (9.0%) and Entamoeba histolytica (8.3%) followed by Ascaris lumbricoides (5.4%) and Cryptosporidium species (5. 1%). CONCLUSION AND RECOMMENDATION: The prevalence of intestinal parasites in diarrheic patients was very high. Institution of appropriate intervention measures are needed to reduce morbidity in such patients.

Infection with HIV and intestinal parasites among street dwellers in Gondar city, northwest Ethiopia.

In Ethiopia human immunodeficiency virus (HIV) infection is a major health and socioeconomic problem. Sex workers, youth, and mobile populations all show increasing prevalence of HIV. However, there is currently no information about the seroprevalence of HIV and the knowledge of HIV among street dwellers in the country. To fill this gap, 404 street dwellers residing in Gondar, northwest Ethiopia, were included in this cross-sectional study. Socio-demographic data, factors that prompted the subjects to become street dwellers, and their knowledge about HIV were all assessed using a structured questionnaire. Stool samples for diagnosis of intestinal parasites and venous blood for HIV antibody testing were collected and processed following standard procedures. Poverty-associated movement to urban areas in search of work was reported as a major factor that forced them to live in the streets, followed by divorce, family death, and addiction and peer pressure. One or more intestinal parasites were found in 67.6% of the street dwellers. Multiple parasitic infections were detected in 27.7%. The prevalence of HIV in the street dwellers was 6.9%. Fifty-nine (16.6%) participants responded that HIV can be transmitted by eating food together. Seventy-three (18%) believed an infected needle cannot transmit HIV, while 51 (12.6%) said HIV can be transmitted by hand shaking. One hundred ninety-two (47.5%) responded that antiretroviral therapy will not prolong the life of HIV-infected individuals. In summary, the prevalence of HIV and intestinal parasitic infection was quite high among street dwellers in Gondar. Therefore, strategies to control HIV and other infectious diseases should include this group, and regular mass deworming may help to reduce the burden of infection.