Development projects to improve maternal and child health: assessing the impact.
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Adult↗
Biomedical subjects
Yemane Berhane
Publications and source records attributed to Yemane Berhane.
Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model.
OBJECTIVE: Verbal autopsy (VA) -- the interviewing of family members or caregivers about the circumstances of a death after the event -- is an established tool in areas where routine death registration is non-existent or inadequate. We assessed the performance of a probabilistic model (InterVA) for interpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community. We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool. METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period. The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches. FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia. Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa. CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency. It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations.
Adolescent↗
Refining a probabilistic model for interpreting verbal autopsy data.
OBJECTIVE: To build on the previously reported development of a Bayesian probabilistic model for interpreting verbal autopsy (VA) data, attempting to improve the model's performance in determining cause of death and to reassess it. DESIGN: An expert group of clinicians, coming from a wide range geographically and in terms of specialization, was convened. Over a four-day period the content of the previous probabilistic model was reviewed in detail and adjusted as necessary to reflect the group consensus. The revised model was tested with the same 189 VA cases from Vietnam, assessed by two local clinicians, that were used to test the preliminary model. RESULTS: The revised model contained a total of 104 indicators that could be derived from VA data and 34 possible causes of death. When applied to the 189 Vietnamese cases, 142 (75.1%) achieved concordance between the model's output and the previous clinical consensus. The remaining 47 cases (24.9%) were presented to a further independent clinician for reassessment. As a result, consensus between clinical reassessment and the model's output was achieved in 28 cases (14.8%); clinical reassessment and the original clinical opinion agreed in 8 cases (4.2%), and in the remaining 11 cases (5.8%) clinical reassessment, the model, and the original clinical opinion all differed. Thus overall the model was considered to have performed well in 170 cases (89.9%). CONCLUSIONS: This approach to interpreting VA data continues to show promise. The next steps will be to evaluate it against other sources of VA data. The expert group approach to determining the required probability base seems to have been a productive one in improving the performance of the model.
Autopsy↗
Use of acetaminophen and the risk of self-reported allergic symptoms and skin sensitization in Butajira, Ethiopia.
BACKGROUND: Studies in developed countries suggest that acetaminophen use is associated with increased risk of asthma, but it is unclear whether this association is causal. OBJECTIVE: To determine the relation among acetaminophen use, asthma, and allergy, and to explore potential biases in acetaminophen use, in a developing country population. METHODS: We surveyed 7649 adults and children from Butajira, Ethiopia, collecting data on self-reported symptoms of allergic disease, skin sensitization to Dermatophagoides pteronyssinus and cockroach, acetaminophen use, and potential confounders. We then collected detailed data on indications for acetaminophen use and reasons for aspirin avoidance in a nested follow-up study. RESULTS: Allergic symptoms increased significantly with frequency of acetaminophen use, with odds ratios in those using >3 tablets in the past month relative to none 1.89 (95% CI, 1.51-2.36) for wheeze, 2.14 (1.72-2.67) for nocturnal shortness of breath, 2.52 (1.99-3.20) for rhinitis, and 1.90 (1.39-2.61) for eczema. Cockroach sensitization was also more common in the highest acetaminophen category (odds ratio, 1.40; 95% CI, 1.10-1.79), but D pteronyssinus sensitization was not. Less than 1% of participants with asthma or wheeze in our nested study reported avoidance of aspirin because of asthma symptoms. None volunteered using acetaminophen to treat allergic symptoms. CONCLUSION: There is a dose-related association between acetaminophen use and self-reported allergic symptoms in this population that is not a result of aspirin avoidance, reverse causation, or other bias. Acetaminophen may therefore be involved in the etiology of asthma and allergic disease.
Acetaminophen↗
The use of simplified verbal autopsy in identifying causes of adult death in a predominantly rural population in Ethiopia.
BACKGROUND: Information on adult mortality is essentially non-existent in Ethiopia particularly from rural areas where access to health services is limited and most deaths occur at home. This study was conducted with the aim of identifying causes of adult death in a rural population of Ethiopia using a simplified verbal autopsy instrument. METHODS: All deaths in the age-group 15-49 years during the period of 1995-99 were taken from computerized demographic surveillance database maintained by the Butajira Rural Health Program. Data on the causes of death were collected from close relatives of the deceased persons by lay interviewers. Causes of death were diagnosed using "expert algorithm" programmed onto a computer. RESULTS: The major causes of death were acute febrile illnesses (25.2%), liver diseases (11.3%), diarrheal diseases (11.1%), tuberculosis (9.7%) and HIV/AIDS (7.4%). Overall communicable diseases accounted for 60.8% of the deaths. The high levels of mortality from communicable diseases reflect the poor socioeconomic development of the country, and the general poor coverage of health and education services in rural Ethiopia. The tools used in this study can easily be added-on to the numerous health surveys conducted in the country. CONCLUSION: The simplified approach to verbal autopsy diagnosis can produce useful data that can effectively guide priority health interventions in rural areas where routine information system is either very weak or non-existent.
Adolescent↗
Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high school youth in Addis Ababa, Ethiopia.
This study was conducted to assess the perceived sufficiency and usefulness of HIV/AIDS information, education and communication (IEC) messages and materials as well as to identify preferences for IEC sources and methods. Data were collected using a self-administered questionnaire and focus group discussions. A total of 901 students in Addis Ababa, Ethiopia, participated in the study. Over three quarters of the respondents believed in the usefulness of IEC. IEC materials were perceived to be useful in increasing knowledge about HIV/AIDS by 456 (51%), to influence attitude by 357 (40%) and to acquire safer sexual practices by 382 (42%) of the respondents. None of the information sources and messages available for high school students highly satisfied the sufficiency indicators. Even though no single information source was highly preferred, radio and television ranked top. Life skills training was the most desired intervention by the students. IEC on HIV/AIDS was able to acquaint students with the disease rather than equipping them with knowledge and skill needed in their daily life. Therefore, appropriate and mutually reinforcing IEC messages with emphasis on life skill training are recommended.
Acquired Immunodeficiency Syndrome↗
Patterns of local migration and their consequences in a rural Ethiopian population.
AIMS: In the context of the Butajira Rural Health Programme (BRHP) in Ethiopia, which has maintained demographic surveillance in selected communities since 1987, this paper investigates patterns of migration and their consequences within that population over a ten year period 1987-1996. METHODS & RESULTS: Based on observations of over 336,000 person-years in nine rural villages and one small town, 48% of individuals migrated in or out of the study area at some stage, as recorded in monthly household visits. There was a net incidence of migration into the urban area, particularly among young adults. Mortality was higher among residents compared with in-migrants, with rates of 10.5 (95% CI 7.5 to 14.9) and 8.2 (95% CI 5.8 to 11.7) per 1,000 person-years respectively after adjustment for age, sex and area of residence, a rate ratio of 1.3. Fertility among in-migrant and resident women was similar, at rates of 0.26 and 0.28 births per reproductive year respectively. CONCLUSIONS: The causes of the observed differences in mortality are not clear, though they may be partly due to self-selection effects among migrants, and may have important implications for future health policy and planning in Ethiopia and other similar settings.
Adolescent↗
Assessment of the oral health status of school children in Addis Ababa.
Oral disease is a major health problem worldwide, and in Ethiopia there is very little epidemiological research done in this field in recent times. This study was carried out to provide baseline information on the major oral health problems (dental caries, periodontal disease, malocclusion, and dental fluorosis) among school children in Addis Ababa. The study was school-based cross-sectional by design. It was conducted in April 2000 with the objective to determine the oral health status of school children who are 12 years and above. A total of 1736 study subjects were selected through a multi-stage sampling procedure from three different categories of schools (private, public and government), proportionate to their respective size of student population. The prevalence of dental caries was determined to be 21.1% and it was found to increase significantly with increasing age, high consumption of sweets, and in those who do not clean their teeth regularly. Periodontal disease affected more than half (53.4%) of the study subjects and was significantly higher in males, those with high consumption of sweets, and those having 'Injera' as staple diet, and those with poor oral hygiene. The prevalence of malocclusion was 23.7%, while crowding and spacing of teeth were found in 23.8% and 18.3% of the subjects, respectively. The prevalence of dental fluorosis was low (1.6%). Health education programs, about healthy diet and practices of adequate oral hygiene, should be promoted in schools through integration into the school curriculum and services.
Adolescent↗
Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia.
BACKGROUND: Delay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care (patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis (health service delay). METHODS: A cross sectional survey that included all the public health centres was conducted in Addis Ababa from August 1 to December 31 1998. Patients were interviewed on the same day of diagnosis using structured questionnaire. RESULTS: 700 pulmonary TB patients were studied. The median patient delay was 60 days and mean 78.2 days. There was no significant difference in socio-demographic factors in those who delayed and came earlier among smear positives. However, there was a significant difference in distance from home to health institute and knowledge about TB treatment among the smear negatives. The health service delay was low (median 6 days; mean 9.5 days) delay was significantly lower in smear positives compared to smear negatives. Longer health service delay (delay more than 15 days) was associated with far distance. CONCLUSIONS: The time before diagnosis in TB patients was long and appears to be associated with patient inadequate knowledge of TB treatment and distance to the health centre. Further decentralization of TB services, the use of some components of active case finding, and raising public awareness of the disease to increase service utilization are recommended.
Adult↗
Sexuality and contraception among never married high school students in Butajira, Ethiopia.
Cross-sectional survey using a self-administered anonymous questionnaire was conducted to assess knowledge, attitude and practice of contraception and sexuality. The questionnaire was filled out in April 2000 by 752 high school students in Butajira, Ethiopia. The mean age of the subjects was 17.1 years. One hundred thirteen never married students (17.5%) claimed to have experienced intercourse; 22.0% of boys and 8.8% of girls. Sexual abstinence was not dictated by perception of risk. About 78% of boys and 91% of the females did not use modern contraceptives at their last sexual intercourse. Nine female students claimed to have been pregnant: two had delivered and seven had induced abortion. The most important reasons for non-use of contraception were lack of adequate knowledge, partner refusal, perception of diminished pleasure and embarrassment to buy. Seventy-one percent of the respondents knew at least one contraceptive method. Over half of the students had no source of information on sexuality and for 25.9% school was the main source of information. The attitude to sexuality was conservative, but liberal to introduction of sex-education at secondary schools. Higher percentage of boys admitted that they had exaggerated their response on sexual matters; girls admitted under-reporting. It is recommended that sex and family life education be discussed openly in schools and included in curricula.
Abortion, Induced↗
Gender, literacy, and survival among Ethiopian adults, 1987 - 96.
OBJECTIVE: To examine relationships between gender, literacy and survival among adults in Meskan and Mareko district, Ethiopia. METHODS: On the basis of an established demographic surveillance system, an open-cohort analysis of 172726 person-years covering the period January 1987 to December 1996 was conducted in 10 randomly selected local communities. FINDINGS: The crude mortality rate was 11.2 per 1000 person-years among adults aged > or =15 years; the values for males and females were 11.9 and 10.6 per 1000 person-years, respectively. Kaplan - Meier estimates showed that literacy and being female were both favourable for survival throughout adulthood. Cox's regression models showed that age, gender, literacy and area (rural lowland, rural highland and urban) were significant factors in survival: younger, female, literate urban dwellers were the most favoured. Gender differences in mortality were small in the rural areas, possibly because of the harsh living conditions and the marginalization of women. Literacy was a more significant factor for survival in the rural areas, where mortality was highest, while gender was more important in the one urban area studied. The levels of literacy were lowest among rural females. CONCLUSION: Special attention should be given to raising literacy levels among rural women with a view to improving their survival.
Adolescent↗
Sociodemographic differentials of adult death in a rural population.
Mortality rates in this country are very high, but most of the deaths occur unattended by a health worker and hence pass unrecorded. As a result, there is a critical lack of information to make sound judgement on what kind of interventions are needed to reduce the high toll of death. This case-control study was conducted in the Meskan and Mareko District, in the ten kebeles that are under continuous demographic surveillance by the Butajira Rural Health Program (BRHP). Included in the study were 515 cases, of which 49.3% were females and 50.7% were males, and 785 controls, of which 52.1% were females and 47.9% males. The most important sociodemographic factors that were found to influence adult death were single marital status (OR 1.63; 95% CI: 1.13, 2.35), having no educated person in the family (OR 1.91; 95% CI 1.11, 3.29), not having gainful occupation (OR 1.40; 95% CI 1.01, 1.82), and perceived poor and very poor economic status (OR 1.97; 95% CI 1.31, 2.94 and OR 2.98, 95% CI 1.73, 5.13, respectively). The male sex (OR 1.46; 95% CI 1.09, 1.95) and living in the rural lowlands (OR 1.54; 95% CI 1.03, 2.31) are also significantly associated with adult mortality. This study revealed that many of the factors associated with adult mortality are related to poor socio-economic conditions and to the prevailing under development of the rural areas.
Adolescent↗
Quality of prescription at a tertiary care pharmacy in Addis Ababa.
The practice of prescribing is one of the critical factors that ensure safety and rational use of drugs. The objective of this study was to describe the quality of prescription in terms of format, legibility and content. The study was carried out in Tikur Anbessa Hospital outpatient pharmacy. All prescriptions that came to the hospital pharmacy over one week period were collected and analyzed. A total of 2191 prescriptions were received by the hospital pharmacy. Only few of the prescriptions had complete information. In about 50% of the prescriptions sex and age were not recorded. On average 15% of the prescriptions were not eligible. Only 13% of the prescriptions received during weekdays, and 8.5% of those received during weekends were scored as good (more than 5 variables out of 8 assessed were rated good). There was no significant difference in the quality between the prescriptions received from Tikur Anbessa hospital and other health institutions. Furthermore, weekday prescriptions were better in quality as compared to weekend prescriptions without considerable difference between day and night shifts. These findings indicate that considerable proportion of prescriptions are not properly written. Since Tikur Anbessa is a teaching center, immediate action needs to be taken to improve the practice of prescription writing.
Cross-Sectional Studies↗