Patterns of Knowledge and Condom Use among Population Groups: Results from the 2005 Ethiopian Behavioral Surveillance Surveys on HIV

Background:Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among different groups of populations selected for behavioral surveillance in Ethiopia.Methods: We used HIV/AIDS Behavioural Surveillance Surveys (BSS) data collected from ten target groups in Ethiopia. These were female sex workers; military personnel; police force; pastoralists; long distance truck drivers; intercity bus drivers; road construction workers; teachers; factory workers and ANC catchment populations. Results: Data from 14;524 individuals were analyzed. The majority were male (63.6). Knowledge of the three preventive methods (abstinence; faithfulness and consistent condom use); misconceptions and comprehensive knowledge was 57; 75and 18.5; respectively. Female sex workers and the defence force showed positive results in using condom during last sexual encounter and did so consistently with non regular sexual partners and paying partners. Women; pastoralists and the illiterate were negatively impacted. Conclusion: Inadequate and incorrect knowledge on HIV/AIDS was observed with special deficiency among the underserved groups such as pastoralists. Women and the older age group were found to be at a disadvantage. The findings indicate the need to expand prevention activities to hard-to-reach groups and such a certain specific population segments. Population groups such as female sex workers and the defense force that were known to be severely affected by the epidemic and are focus of HIV/AIDS interventions showed positive behaviors. Although this is encouraging; considerable proportion of the study groups did not use condom during sex with non regular partners. This underscores the importance of intensifying interventions across all groups and extended to their localities

Vitamin A supplementation on child morbidity.

OBJECTIVE: To determine the impact of vitamin A supplementation on child morbidity and nutritional status. DESIGN: A community based follow-up (interventional) in nature. SETTING: Two randomly selected Weredas (districts) of Tigray, North Ethiopia were studied between 1996 and 1997. SUBJECTS: Four thousand seven hundred and seventy children aged between six and 72 months, selected using a multi-stage sampling procedure were enrolled and clinically assessed for xerophthalmia and nutritional status. A sub-sample of these children (n = 281) was further assessed for their serum retinol levels. MAIN OUTCOME MEASURES: The pre and post intervention data on xerophthalmia, morbidity, nutritional status and serum retinol levels were compared. RESULTS: Vitamin A capsule coverage of 87% in all the villages of the Weredas and a statistically significant (p < 0.05) reduction in the prevalence of Bitot's spot (from 1.5 to 0.5), fever (from 29.8 to 14.2), diarrhoea (from 30.2 to 18.2), oedema (from 9.2 to 3.2), measles (from 14.0 to 6.2), conjunctivitis (from 10.2 to 3.0), stunted (from 64.2 to 42.7), wasted (from 12.8 to 2.5) and underweight (from 46.2 to 24.2). The proportion of children with normal serum retinol concentration (> 0.7 micromole/L) has also improved significantly (from 36.8 to 56.2). CONCLUSION: In conclusion, the significant improvement in morbidity and nutritional status that followed the intervention programme although encouraging, it still indicates the importance of coupling periodic provision of Vitamin A capsules with nutrition education.

Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia.

SETTING: Three districts of Oromia Region in Arzi Zone, Ethiopia. OBJECTIVES: To determine the rate of defaulting from directly observed treatment, short course (DOTS) for tuberculosis and identify associated factors. DESIGN: A case control study. Records of 1367 new tuberculosis patients put on DOTS during a period of 30 months (1 July 1997-31 December 1999) were reviewed to determine the defaulting rate. Cases were defaulters and controls were selected by paired matching of sex and age using the lottery method. All study subjects were actively traced and interviewed by trained interviewers using a pre-tested structured questionnaire. RESULTS: The overall rate of defaulting from DOTS was calculated to be 11.3%, while the rate in sputum smear-positive cases was 11.6%. Defaulting was highest (81%) during the continuation phase of treatment. Medication side effects were significantly associated with defaulting (OR = 4.20, 95% CI 1.51-11.66), while adequate knowledge and family support were found to be possible protective factors (OR = 0.04, 95% CI 0.02-0.1 and OR = 0.19, 95% CI 0.08-0.46, respectively). CONCLUSIONS: Major factors contributing to high rates of defaulting were found to be lack of family support, inadequate knowledge about treatment duration and medication side effects. Control programmes that take these factors into consideration should be successful in reducing defaulting.

Factors associated with HIV-1 infection among sex workers of Addis Ababa, Ethiopia.

OBJECTIVE: To study the prevalence and risk factors for HIV infection among sex workers of Addis Ababa, Ethiopia. DESIGN AND METHODS: Cross-sectional survey on socio-demographic characteristics, behaviours, and HIV serological status of sex workers attending two health centres of Addis Ababa. RESULTS: HIV prevalence among sex workers was 274 of 372 (73.7%). Several factors were significantly associated with an increased risk of being HIV-infected [among others, working in 'shared rooms', high number of clients, use of injectable hormones, and positive Treponema pallidum particle agglutination (TPPA) serology], and others with a decreased risk (being born in Addis Ababa, high level of education, peer education on sex work, condom use, use of oral pill, and use of condoms for contraception). Of interest, sex workers who were using condoms for contraception were, compared with others, more likely to use condoms consistently (65 versus 24%, respectively; P < 0.001), and less likely to be HIV-infected (55 versus 86%, respectively; P < 0.001). In multivariate analysis [log-binomial model, giving estimates of the prevalence ratio (PR)], being born in Addis Ababa (PR = 0.74; 95% confidence interval (CI), 0.61-0.91), using condoms for contraception (PR = 0.73; 95% CI, 0.64-0.85), and a positive TPPA serology (PR = 1.21; 95% CI, 1.09-1.36), remained significantly associated with HIV infection. CONCLUSIONS: HIV prevalence was remarkably high among sex workers of Addis Ababa. Condom use was higher, and HIV prevalence lower, in sex workers using condoms not only for prevention of HIV and sexually transmitted diseases, but also for contraceptive purpose. This finding is of particular interest for its implications for prevention strategies among sex workers in the developing world.

Burden of disease analysis in rural Ethiopia.

We describe the design and results of a study conducted to determine the magnitude and healthy years of life lost due to morbidity and mortality for major causes in rural Ethiopia. The design included a cross-sectional household survey to determine the magnitude and causes of morbidity and a retrospective longitudinal study to determine the magnitude and causes of mortality. The study was conducted between June 1 and July 12, 1998, within the Butajira Rural Health Project (BRHP) setting. The source population were all people residing in the district and the study population were the sample of households for the BRHP which are the inhabitants of nine rural and one urban Kebeles (villages) in Butajira area, which is located about 130 Kms south of Addis Ababa. The sample was previously selected randomly using probabilities proportional to size, constituting 10% of the total district population (approximately 32,000) and has been under continuous demographic surveillance since 1987. All individuals who were sick two weeks preceding the survey and all those who deceased in the two years prior to the survey were included in the present analysis. The Disability-Adjusted Life Years (DALYs) lost was used as a measure of the burden of disease from the analyzed data. According to the results, prevalence of morbidity within the preceding two weeks was 13.8% (95% CI = 12.8-14.8). In addition, there were 875 deaths during the preceding two years making an annual mortality rate of 13.5 per 1,000 populations (95% CI = 13.13-13.87). The total burden of disease in terms of DALYs lost calculated from these data was 59,125 per 100,000 populations (95% CI = 58,591-59,659). Communicable, maternal, perinatal and nutritional problems contributed to 72% of the total DALYs lost; non-communicable diseases contributed to 24% of the DALYs lost while the proportion of DALYs lost due to injuries was only 4%. The results were similar to previous estimates for countries in Sub-Saharan Africa.