Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Ethiopia.

The Federal Ministry of Health, Ethiopia, recognised the potential of the Practical Approach to Care Kit (PACK) programme to promote integrated, comprehensive and evidence-informed primary care as a means to achieving universal health coverage. Localisation of the PACK guide to become the 'Ethiopian Primary Health Care Clinical Guidelines' (PHCG) was spearheaded by a core team of Ethiopian policy and technical experts, mentored by the Knowledge Translation Unit, University of Cape Town. A research collaboration, ASSET (heAlth Systems StrEngThening in sub-Saharan Africa), has brought together policy-makers from the Ministry of Health and health systems researchers from Ethiopia (Addis Ababa University) and overseas partners for the PACK localisation process, and will develop, implement and evaluate health systems strengthening interventions needed for a successful scale-up of the Ethiopian PHCG. Localisation of PACK for Ethiopia included expanding the guide to include a wider range of infectious diseases and an expanded age range (from 5 to 15 years). Early feedback from front-line primary healthcare (PHC) workers is positive: the guide gives them greater confidence and is easy to understand and use. A training cascade has been initiated, with a view to implementing in 400 PHC facilities in phase 1, followed by scale-up to all 3724 health centres in Ethiopia during 2019. Monitoring and evaluation of the Ministry of Health implementation at scale will be complemented by indepth evaluation by ASSET in demonstration districts. Anticipated challenges include availability of essential medications and laboratory investigations and the need for additional training and supervisory support to deliver care for non-communicable diseases and mental health. The strong leadership from the Ministry of Health of Ethiopia combined with a productive collaboration with health systems research partners can help to ensure that Ethiopian PHCG achieves standardisation of clinical practice at the primary care level and quality healthcare for all.

Menstrual problems and associated factors among students of Bahir Dar University, Amhara National Regional State, Ethiopia: A cross-sectional survey.

INTRODUCTION: Menstrual problems are the most common gynecologic complaints. The prevalence is highest in the 20 to 24-year-old age group and decreases progressively thereafter. They affect not only the woman, but also family, social and national economics as well. However, Population studies on Menstrual problems and associated factors were very little for university students in Ethiopia. METHODS: Institutional based quantitative cross-sectional study was employed at Bahir Dar University from October 14 to 20, 2010, Ethiopia. Stratified sampling technique was used and 491 study subjects were randomly selected from faculties. Only 470 respondents had given complete response for the self-administered questionnaire and were included in the final analysis. Data was entered and analyzed with SPSS version 16.0 windows. The main statistical method applied was logistic regression (unconditional) and both the classical bivariate and the multivariate analyses were considered. RESULTS: The prevalence of dysmenorrhea and premenstrual syndrome were 85.1% and 72.8%, respectively. The most contributing factors remained to be statistically significant and independently associated with dysmenorrhea were having menstrual cycle length of 21-35 days (AOR=0.16, 95%CI: 0.04, 0.71), family history of dysmenorrhea (AOR=3.80, 95%CI: 2.13, 6.78) and circumcision (AOR=1.84, 95%CI: 1.001, 3.386) while with premenstrual syndrome were educational status of mothers being certified in certificate and beyond (AOR=0.45, 95%CI: 0.25, 0.83), living in Peda campus (AOR=2.11, 95%: 1.30, 3.45), having irregular menstruation (AOR=1.87, 95%CI: 1.17, 2.99) and family history of premenstrual syndrome (AOR=4.19, 95%CI: 2.60, 6.74). CONCLUSION: The prevalence of menstrual problems among students of Bahir Dar University was very high. Menstrual cycle length, family history of dysmenorrhea and circumcision were the most contributing factors associated with dysmenorrhea while educational status of mothers, regularity of menstruation, and family history of premenstrual syndrome were for premenstrual syndrome. Health education, appropriate medical treatment and counseling, should be accessible and persistently provided to the affected students by Bahir Dar University. Maximum effort is needed to eliminate circumcision by all levels and further steps that would enable females to join their college education should be applied.

Effect of nutritional factors on adherence to antiretroviral therapy among HIV-infected adults: a case control study in Northern Ethiopia.

BACKGROUND: Adherence to antiretroviral treatment is critical for suppression of viral replication, reduced destruction of CD(4) cells, prevention of viral resistance, promotion of immune reconstitution and slowed disease progression. This study sought to determine the effect of nutritional factors on adherence to ART among HIV-infected adults on ART. METHODS: Matched case control study design (matched by age and sex) was employed. Data was collected from ART registration chart, pre-tested structured data extraction format, anthropometric measurements and by interview. Conditional logistic regression was used to compute the relevant associations among the variables by STATA version 10. RESULTS: From 174 paired subjects participated in the study 80 (46%) pair were males and 94 (54%) pair were females on ART for at least one year prior to the survey. The mean age (±SD) for the non-adherent was 38.4 ± 8.1 years and for the adherent subjects was 38.5 ± 8.4 years. Malnutrition with BMI less than 18.5 Kg/m(2) in the adherent group was 14 (8%) and that of the non-adherent group was 74 (42.5%) which was associated with non-adherence to ART (AOR 10.0, 95%CI 4.3 - 54.7). Inability to get enough and quality food was also associated with non-adherence to ART (AOR 2.1, 95%CI 1.1 - 11.5). CONCLUSIONS: Malnutrition, inability to get enough and/or quality food and consumption pattern which is less than three meals per day were significantly associated with non-adherence to ART. Therefore, the capacity to effectively manage the food and nutrition implications of ART adherence is a critical factor in the success of antiretroviral therapy in resource limited settings.

Nutritional status, intestinal parasite infection and allergy among school children in northwest Ethiopia.

BACKGROUND: Parasitic infections have been shown to have deleterious effects on host nutritional status. In addition, although helmintic infection can modulate the host inflammatory response directed against the parasite, a causal association between helminths and allergy remains uncertain. The present study was therefore designed to evaluate the relationship between nutritional status, parasite infection and prevalence of allergy among school children. METHODS: A cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer's instruction. RESULT: A total of 405 children (with mean age of 12.09.1 ± 2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117-2076, n=80) and 610 IU/ml (143-1833, n=20), respectively, in children without and with intestinal parasite infection (Z=-0.198, P>0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy. CONCLUSION: The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.

Medical students' attitudinal changes towards cadaver dissection: a longitudinal study.

BACKGROUND: Recently, not only the medical school curriculum but also medical students' attitude towards cadaver-based learning of anatomy has changed. This investigation is therefore designed to analyse students' attitudes towards human cadaveric dissection before and after exposure to dissection. METHODS: A longitudinal survey was conducted among second year medical students in 2010 at the college of Medicine and Health Sciences, University of Gondar. All second year medical students (n=147) were included in the study where their attitudes were surveyed at three time points (one week prior to dissection session, a week after the initiation of dissection and eight weeks after the second survey). Three standardized and pretested questionnaires prepared in English were used to collected relevant data from the subjects. RESULTS: Out of the 147 students 85.7% were males. The subjects' age ranged between 18 and 23 with a mean and standard deviation of 19.5±1 years. This study has revealed that among majority of the students fear and nausea have decreased while their interest and excitement has increased on subsequent exposure to dissection (P<0.05). About 75% of students considered the dissection room as slightly or highly stressful. Smell of the cadaver and eye irritation as a result of the chemicals in it were the major aspects identified as making the dissecting room stressful. The result also showed that almost all (99%) considered cadaver dissection had very important educational value for anatomy learning. CONCLUSION: In the majority of the students fear and nausea had decreased while interest and excitement had increased on subsequent exposure to dissection. It also showed that chemical odour and eye irritations were the leading factors which create discomfort in the dissection room even though anatomical dissection by itself was not considered as a stressor. Thus, instructors are recommended to adequately prepare students mentally and emotionally before the commencement of the dissection session for an exciting and stress free anatomy learning though dissection.