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Background: Syphilis is a highly contagious Sexually Transmitted Infection posing a significant public health challenge, especially in developing countries including those in sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. There is scarce data on national syphilis prevalence estimate and the associated factors in Ethiopia. This along with our limited knowledge extent of clustering among female sex workers across towns in the country, a critical gap in information we aimed to fill through this analysis. Methods: The study was a community based cross-sectional, bio-behavioral survey conducted among FSWs in 16 cities and major towns in Ethiopia by using a Respondent Driven Sampling method. Survey data were collected through an interviewer administered questionnaire and blood samples were collected for syphilis, HIV, and hepatitis serological testing from 6085 participants. In this analysis, we employed descriptive statistics to summarize data on the study variables. We used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the outcome (syphilis prevalence), while also accounting for the clustering effect. Result: Of the 6085 female sex workers included in the study, a majority (96.1%) were in the 20-24 years age group. The overall prevalence of syphilis among female sex workers in the 16 cities and major towns of Ethiopia was 6.2%. Being in the age group of 30-34 (AOR=2.64; 95% CI=1.40, 4.98), and 35-59 (AOR=4.7; 95% CI=2.5, 8.86), being divorced/widowed (AOR=1.37; 95% CI=1.03, 1.82), having no formal education (AOR=3.38; 95% CI=2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR=2.77; 95% CI=1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR=1.80; 95% CI=1.21, 2.69) were significantly associated with syphilis infection among female sex workers. Conclusion: The prevalence of syphilis was high among female sex workers in Ethiopia. Being divorced/widowed or in the older age group, and having low level of education were significantly associated with increased risk of syphilis. The high prevalence and the determinant identified in the study need to be considered in the planning of comprehensive interventions to control syphilis infection among female sex workers in Ethiopia.

Background Though appropriate condom use is an effective and cost-efficient strategy for HIV prevention, its use is inconsistent among female sexual workers (FSWs). Evidence on the magnitude and the drivers of inconsistent condom use across studies among FSWs is limited in coverage and scope. This analysis aims to determine the prevalence and associated factors among FSWs in Ethiopia. Methods This analysis uses the data from a cross-sectional ‘National HIV and sexually transmitted infections. Bio-behavioral Survey’ conducted from December 2019 to May 2020 using a respondent driven sampling technique. Descriptive statistics and multilevel logistic regression models were used to summarize data and measure strength of association. Statistical significance was determined by using P-value less than 0.05 or 95% CI that didn’t include unity. Results Overall, 6,085 FSWs from 16 cities and towns participated in the study. Participants’ mean (SD) age was 26.4 (± 6.06). The prevalence of inconsistent condom use across the 16 cities/towns was 17.1% [95% CI (16.5, 17.8)]. Factors independently associated with inconsistent condom use were being married/cohabiting [AOR = 1.56; (95% CI (1.03, 2.23), moderate to severe depression [AOR = 1.43; 95% CI (1.13,1.82)], alcohol dependence [AOR = 1.56; 95% CI (1.06, 2.31)], any drug use [AOR = 1.43; 95% CI (1.14–1.79)], older age (35–59 years) [AOR = 1.29; 95% CI (1.01, 1.64)], sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], sex selling location change [AOR = 1.27; 95% CI (1.06, 1.51)], length of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], number of non-paying sexual partner [AOR = 1.77; 95% CI(1.48, 2.11)], sex selling experience more than two cities [AOR = 3.01;95% CI(2.27, 3.99)], rape or forced sex [AOR = 1.75; 95% CI (1.43, 1.55)], not having comprehensive HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)], newly diagnosed HIV [AOR = 1.52; 95% CI (1.19, 1.95)], and lack of condom access at the workplace [AOR = 2.1; 95% CI (1.69, 2.67)]. Conclusion Prevalence of inconsistent condom use among FSWs was 17%. Factors independently associated with inconsistent condom use included marital and education status, depression, alcohol dependence, drug use, sexual violence, and increased number of nonpaying partners. Program and individual level interventions need to be considered to enhance consistent condom use among FSWs.

Background: Coronavirus disease 2019 (CoVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). In the absence of treatment for this virus, there is an urgent need to find alternative public health strategies to control the spread. Here, we have conducted an online search and summarize the global COVID-19 pandemic situation and recommend potential mitigation strategies in the context of Ethiopia. Result: The most common global COVID-19 mitigation strategies include, whole of government approach including individual, community and environmental measures, detecting and isolating cases, contact tracing and quarantine, social and physical distancing measures including for mass gatherings and international travel measures. Social and physical distancing alone could prevent the pandemic from 60-95%. Moreover, detecting and isolation of cases were found to be crucial while access to testing was found to the global challenge. Individual measures including proper hand washing were also reported to be effective measures in preventing the pandemic. Asymptomatic cases of COVID-19 ranged from 25% to 80% and as a result, countries are revising the case definition for early detection of mild symptomatic cases of COVID-19 with inclusion of Chills, Muscle pain and new loss of taste or smell in addition to Cough, Shortness of breath, Fever and Sore throat. Ethiopia is also unique in the aspects of sociocultural prospects while more than 99.3% of the population has a religion. Moreover, 69% of the population is under the age of 29 years old and the health policy in the country focused on prevention and primary health care. Conclusion: While recommendations may change depending on the level of outbreak, we conclude that in most countries have benefited from early interventions and in setups like Africa including Ethiopia where health system capability is limited, community engagement supported by local evidence with strict implementation of social and physical distancing measures is mandatory. Community level case detection could enhance early identification of cases. Validation and use of rapid test kits could be vital to increase access for testing. Revision of case definitions for COVID-19 could be important for early detection of cases.

Background Hepatitis B and C virus infections are endemic diseases in sub-Saharan Africa, the region with the highest prevalence of these infections in the world. Female sex workers are exposed to sexually transmitted infections, including hepatitis B and C, because of their high-risk sexual behavior and limited access to health services. There are no large-scale data on the prevalence of hepatitis B and C virus infections among female sex workers in Ethiopia, a critical gap in information this study aimed to fill. Methods This was a cross-sectional, biobehavioral survey conducted from December 2019—April 2020 among 6085 female sex workers aged ≥15 years and residing in sixteen (16) regional capital cities and selected major towns of Ethiopia. Blood samples were collected from the participants for hepatitis B and C virus serological testing. The data were collected using an open data kits (ODK) software and imported into STATA version16 for analysis. Descriptive statistics (frequencies and proportions) were used to summarize data on the study variables. Bivariable and multivariable logistic regression analyses were conducted to determine the strength of association between independent variables (risk factors) and the outcome (hepatitis B and C virus infection). Adjusted Odd ratio (AOR) was used to determine independent associations, 95% confidence interval to assess precision of the estimates, and a P value ≤ 0.05 to determine statistically significant. Results The prevalence of hepatitis B and C infections among the 6085 female sex workers was 2.6% [(95% CI (2.2,2.8)] and 0.5% [(95% CI (0.4,0.7)], respectively. Female sex workers who had 61–90 and ≥91 paying clients in the past six months [(AOR = 1.66; 95% CI, (0.99, 2.79); P = 0.054] and [(AOR = 1.66 95% CI, (1.11, 2.49); P = 0.013], respectively, age at first sex selling of 20–24 and >25 years [(AOR = 1.67; 95% CI, (1.14, 2.44); P = 0.009)] and [(AOR = 1.56; 95% CI (1.004, 2.43); P = 0.048)], respectively, known HIV positive status [(AOR = 1.64; 95% CI (1.03, 2.62); P = 0.036] were significantly associated with the prevalence of hepatitis B virus infection. Similarly, hepatitis C was significantly associated with, age at first sex ≤15 years and age 16–20 years [(AOR = 0.21; 95%CI (0.07,0.61); P = 0.005)] and [(AOR = 0.18; 95% CI (0.061, 0.53); P = 0.002)], respectively, known HIV positive status [(AOR = 2.85; 95%CI (1.10,7.37); P = 0.031)] and testing positive for syphilis [(AOR = 4.38; 95% CI (1.73,11.11); P = 0.002)], respectively. Conclusion This analysis reveals an intermediate prevalence of hepatitis B and a low prevalence of hepatitis C infection among female sex workers in Ethiopia. It also suggests that population groups like female sex workers are highly vulnerable to hepatitis B, hepatitis C, and other sexually transmitted infections. There is a need for strengthening treatment and prevention interventions, including immunization services for hepatitis B vaccination, increasing HCV testing, and provision of treatment services.

Background Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. Methods Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. Results A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. Conclusion Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.

Background The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country’s response to the epidemic. Methods We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants’ level of unawareness of their HIV-positive status (adjusted for ARV status). Results We interviewed 20,170 survey participants 15–64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15–24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status. Conclusion One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.

Background: Surgical task-sharing is a strategy allowing trained mid-level providers to perform essential surgery in low-resource areas. Despite case volumes second only to obstetric surgery, no large-scale comparative study has been previously performed examining task-sharing for acute abdominal surgery. Both general surgeons and mid-level emergency surgical officers (ESOs) perform laparotomies in the same facilities in Ethiopia, presenting an opportunity for comparative analysis of outcomes. Methods: A three-year retrospective study collected surgical case data at 4 general hospitals (n = 1540) with ESOs and MD surgeons, and 2 comparison samples from a primary (n = 100) and a tertiary (n = 142) hospital. Bivariate analysis compared mortality and morbidity stratified by provider type, sub-stratified by facility and twelve categories of emergency abdominal surgery. Multivariable logistic regression modeled the impact of provider training level on odds of perioperative mortality, complication and SSI rates, adjusting for patient age, gender, hospital facility, distance score and preoperative health score. Results: Both overall and within each general hospital across 12 diagnosis categories of emergency abdominal surgery, no significant additional risk was found for ESO mortality, complication and SSI rates. Logistic regression modeling found no additional odds of mortality, complication or surgical site infection for ESOs, controlling for patient age, gender, treatment site, distance travelled, and preoperative health. Conclusion: Emergency surgical officers at general hospitals performed a wide range of abdominal surgery with similar risks of in-hospital mortality, perioperative morbidity and surgical site infection versus similar procedures performed by physician surgeons. Cases performed by ESOs included appendectomy, bowel decompression, bowel resection, perforated peptic ulcer repair, colostomy creation, hemicolectomy, salpingectomy and oophorectomy, and abdominal trauma management with no additional detectable risk. Referral to surgical specialists remains essential in abdominal cases involving liver, spleen, gallbladder, pancreas, and complex vascular or oncological complications. Funding Statement: The funding source for this study was a grant provided by Dr. Mark Hardy, MD, Columbia University Department of Surgery, partially supported by the Il-song Education Foundation and Hallym University Global Medicine Program. Declaration of Interests: The authors have no financial conflicts of interest to disclose. Ethics Approval Statement: Ethical approval was granted by the Columbia University Medical Center Institutional Review Board with a designation of Exempt Research (IRB-AAAR9424) and by the Ethiopian Federal Ministry of Health (Ref. MT(1)/45/300).

Objective To describe pediatric ART scale-up in Ethiopia, one of the 21 global priority countries for elimination of pediatric HIV infection. Methods A descriptive analysis of routinely collected HIV care and treatment data on HIV-infected children (

Nevirapine resistance mutations arise commonly following single or extended-dose nevirapine (ED-NVP) prophylaxis to prevent mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), but decay within 6–12 months of single-dose exposure. Use of ED-NVP prophylaxis in infants is expected to rise, but data on decay of nevirapine resistance mutations in infants in whom ED-NVP failed remain limited. We assessed, in Ethiopian infants participating in the Six-Week Extended Nevirapine (SWEN) Trial, the prevalence and persistence of nevirapine resistance mutations at 6 and 12 months following single-dose or up to 6 weeks of ED-NVP, and correlated their presence with the timing of infection and the type of resistance mutations. Standard population genotyping followed by high-throughput cloning were done on dried blood spot samples collected during the trial. More infants who received ED-NVP had nevirapine resistance detected by standard population genotyping (high frequencies) at age 6 months compared with those who received single-dose nevirapine (SD-NVP) (58% of 24 vs. 26% of 19, respectively; p = 0.06). Moreover, 56% of ED-NVP-exposed infants with nevirapine resistance at age 6 months still had nevirapine resistance mutations present at high frequencies at age 1 year. Infants infected before 6 weeks of age who received either SD- or ED-NVP were more likely to have Y181C or K103N; these mutations were also more likely to persist at high frequencies through 1 year of age. HIV-infected infants in whom ED-NVP prophylaxis fails are likely to experience delayed clearance of nevirapine-resistant virus in the first year of life, which in turn places them at risk for early selection of multidrug-resistant HIV after initial therapy with nonnucleoside reverse transcriptase inhibitor-based regimens.

In the absence of chemoprophylaxis, HIV-1 transmission occurs in 13-42% of infants born to HIV-1 positive mothers. All exposed infants acquire maternal HIV-1 antibodies that persist for up to 15 months, thereby hampering diagnosis. In resource limited settings, clinical symptoms are the indices of established infection against validated laboratorybased markers. Here we enrolled 1200 children hospitalized for diarrheal and other illnesses. 20-25% of those tested, aged 15 months or younger, were found to be HIV-1-seropositive. Where sufficient plasma was available, HIV-1 RNA detection was performed using a subtype-insensitive assay, with 71.1% of seropositive infants presenting with diarrhea showing positive. From sub-typing analysis, we identified that viruses of the C’ sub-cluster were predominated amongst infants. Although this study may overestimate the HIV-1 frequency through testing symptomatic infants, diarrhea can be seen as a useful marker indicating HIV-1 infection in infants less than 15 months old.

Background Malaria and HIV/AIDS constitute major public health problems in Ethiopia, but the burden associated with malaria-HIV co-infection has not been well documented. In this study, the burden of malaria among HIV positive and HIV negative adult outpatients attending health facilities in Oromia National Regional State, Ethiopia was investigated. Methods A comparative cross-sectional study among HIV-positive patients having routine follow-up visits at HIV care and treatment clinics and HIV-seronegative patients attending the general medical outpatient departments in 12 health facilities during the peak malaria transmission season was conducted from September to November, 2011. A total of 3638 patients (1819 from each group) were enrolled in the study. Provider initiated testing and counseling of HIV was performed for 1831 medical outpatients out of whom 1819 were negative and enrolled into the study. Malaria blood microscopy and hemoglobin testing were performed for all 3638 patients. Data was analyzed using descriptive statistics, Chi square test and multivariate logistic regression. Results Of the 3638 patients enrolled in the study, malaria parasitaemia was detected in 156 (4.3 %); malaria parasitaemia prevalence was 0.7 % (13/1819) among HIV-seropositive patients and 7.9 % (143/1819) among HIV-seronegative patients. Among HIV-seropositive individuals 65.4 % slept under a mosquito bed net the night before data collection, compared to 59.4 % of HIV-seronegative individuals. A significantly higher proportion of HIV-seropositive malaria-negative patients were on co-trimoxazole (CTX) prophylaxis as compared to HIV-malaria co-infected patients: 82 % (1481/1806) versus 46 % (6/13) (P = 0.001). HIV and malaria co-infected patients were less likely to have the classical symptoms of malaria (fever, chills and headache) compared to the HIV-seronegative and malaria positive counterparts. Multivariate logistic regression showed that HIV-seropositive patients who come for routine follow up were less likely to be infected by malaria (OR = 0.23, 95 % CI = 0.09–0.74). Conclusion The study documented lower malaria prevalence among the HIV-seropositive attendants who come for routine follow up. Clinical symptoms of malaria were more pronounced among HIV-seronegative than HIV-seropositive patients. This study also re-affirmed the importance of co-trimoxazole in preventing malaria symptoms and parasitaemia among HIV- positive patients.

UNICEF/WHO recommends that infants born to HIV-infected mothers who do not have access to acceptable, feasible, affordable, sustainable, and safe replacement feeding should be exclusively breastfed for at least 6 months. The aim of three trials in Ethiopia, India, and Uganda was to assess whether daily nevirapine given to breastfed infants through 6 weeks of age can decrease HIV transmission via breastfeeding.HIV-infected women breastfeeding their infants were eligible for participation. Participants were randomly assigned to receive either single-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborns after birth) or 6 week extended-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborn babies after birth plus nevirapine 5 mg daily from days 8-42 for the infant). The randomisation sequences were generated by computer at a central data coordinating centre. The primary endpoint was HIV infection at 6 months of age in infants who were HIV PCR negative at birth. Analyses were by modified intention to treat, excluding infants with missing specimens and those with indeterminate or confirmed HIV infection at birth. These studies are registered with ClinicalTrials.gov, numbers NCT00074399, NCT00061321, and NCT00639938.2024 liveborn infants randomised in the study had at least one specimen tested before 6 months of age (1047 infants in the single-dose group and 977 infants in the extended-dose group). The modified intention-to-treat population included 986 infants in the single-dose group and 901 in the extended-dose group. At 6 months, 87 children in the single-dose group and 62 in the extended-dose group were infected with HIV (relative risk 0.80, 95% CI 0.58-1.10; p=0.16). At 6 weeks of age, 54 children in the single-dose group and 25 in the extended-dose group were HIV positive (0.54, 0.34-0.85; p=0.009). 393 infants in the single-dose group and 346 in the extended-dose group experienced grade 3 or 4 serious adverse events during the study (p=0.54).Although a 6-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at 6 weeks of age, the lack of a significant reduction in the primary endpoint-risk of HIV transmission at 6 months-suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breast milk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high.US National Institutes of Health; US National Institute of Allergy and Infectious Diseases; Fogarty International Center.

BackgroundExpanded access to HIV therapy in the developing world raises serious concerns regarding the potential emergence and transmission of drug-resistant HIV strains. Although HIV drug resistance surveillance is recommended to track transmitted HIV drug resistance among newly infected individuals, the financial constraints in resource-limited countries prohibit such surveillance on a regular basis. The World Health Organization (WHO) recently introduced guidelines to address this issue.MethodsA survey was conducted in Ethiopia following the WHO guidelines to assess transmitted HIV drug resistance among recently HIV-infected individuals in Addis Ababa. Antiretroviral drug usage started 3 years earlier than commencement of the current expanded access to antiretroviral therapy in Ethiopia.ResultsOf 75 eligible samples, 39 (52%) were successfully sequenced and genotyped in the protease and reverse transcriptase region, using both the ViroSeq® and TrueGene® genotyping systems, and analysed for drug resistance mutations using an algorithm from the Stanford HIV Reverse Transcriptase and Protease Database. The analysis revealed that transmitted HIV drug resistance in Addis Ababa is below the 5% threshold level for all three classes of antiretrovirals.ConclusionsThe current first-line antiretroviral therapy strategy can be used with confidence in Ethiopia at this time; however, Ethiopia should conduct similar periodic surveys that include the capitals of Ethiopia's larger regional states to ensure early detection of any changes in the country's HIV drug resistance trend.

With HAART PMTCT interventions can reduce the risk of MTCT below 2%. However, low uptake of VCT is challenging effectiveness of PMTCT programs in sub-Saharan Africa. The aim of this study is to identify factors that determine VCT uptake among pregnant women attending ANC services.A case-control study was conducted from August 30, 2005 - November 30, 2005 among pregnant women attending ANC PMTCT services at Teklehaimanot Health Center and Gandhi memorial Hospital in Addis Ababa City. Cases were pregnant mothers who accepted VCT (n=202) and controls were pregnant mothers who refused VCT (n=200). Data was collected by counselor nurses working at the respective servicesFactors that determine VCT acceptance were women's perceived ability to cope with a positive result (OR = 5.5, 95% CI 3.5-8.5, MHOR = 6.3, 95% CI 3.9-10.2); perceived favorable reaction of husband's after sharing positive test result (OR = 2.7 95% CI 1.4-5.1, MHOR = 2.9, 95% CI 1.4-5.7); perceived positive community response (OR = 2.2 95% CI 1.1-4.2, MHOR = 2.6 95% CI 1.3-5.2); perceived ability to get continuous medical care if found out to be positive (OR = 2.0, 95% CI 1.2-3.5, MHOR = 2.4, 95% CI 1.3-4.5).Women's perceived ability to cope with a positive result, accesses to medical care, fear of husband's negative reaction and the stigma and discrimination following a positive test result were key determinants of uptake of VCT. Therefore, increasing uptake of VCT/PMTCT services needs policy makers and service providers' effort to promote couple counseling, intensifying the fight against stigma and discrimination and ensuring continuous HIV/AIDS related medical care.

At Ethio-Swedish Children's Hospital Addis Ababa, Ethiopia, children admitted with a diagnosis of tetanus during January 1989- December 1998 were studied. During the 10 year study period there were 113 patients admitted with a diagnosis of tetanus. Sixty two (54.9%) of them were newborns and the rest 51 (45.1%) were children between the age of 1 and 12 years. Fifty six (90.3%) of the newborns were born at home and 43 (69.4%) of the mothers didn't have antenatal care. The median age on admission was 7 days. The umbilicus was assumed to be the portal of entry for all the cases with neonatal tetanus. Forty six (74.2%) of those with neonatal tetanus died in the hospital. Significantly high case fatality rate was seen in neonates with incubation period less than 7 days, onset time 48 hours or less, high pulse rate140/minute and in those having fever. In non-neonates, the median age at admission was 9 years and the commonest site of entry was lesion on the lower extremities. Sixteen (31.4%) died in the hospital. The outcome was poor in those with onset time of 48 hours or less and in those presenting within 72 hours after the onset of illness. The overall mortality is high. Due attention needs to be given to children with tetanus having poor prognostic factors, particularly among newborns. Antenatal care needs to be promoted. A community based study is recommended to determine the true magnitude of the problem.

Nutritional rickets contributes to the high burden of illness and death among Ethiopian children below 5 years of age. Lack of adequate information appears to have negatively influenced the impact of prevention and treatment programs.The objective of this systematic review is to review existing body of knowledge about nutritional rickets in Ethiopia and develop recommendations that will guide development of strategies for effective interventions and research.Published and unpublished information on nutritional rickets in Ethiopia was collected systematically. The information was critically reviewed and discussed in the context of regional and global situation.The major cause of nutritional rickets in Ethiopian children is lack of exposure to sunshine and/or inadequate intake of vitamin D. Lack of awareness and traditional beliefs are major causes for not exposing infants to sunshine. The disease is associated with poor socioeconomic status, low birth weight, protein-energy malnutrition and common childhood infections. Severe form of rickets is commonly seen at about 18 months of age. Rickets predisposes Ethiopian children to pneumonia. Diagnostic criteria used in most studies include two or more clinical signs and a characteristic radiological or biochemical abnormality. There are critical gaps in our knowledge about the epidemiology, ecology, and potentially effective interventions to prevent and treat rickets in Ethiopian children.Most of the studies on nutritional rickets in Ethiopia have been conducted in hospital settings. There is a need for well designed epidemiological and ecological studies. The biologic basis for the striking association between PEM and active rickets seen in Ethiopia needs to be determined The role of calcium deficiency, the part played by genetic factors, the nature of the association between the duration of breastfeeding and rickets, and the role of complimentary feeds in Ethiopian children need to be explored. Studies are required to determine the amount of sunshine required to prevent rickets in Ethiopian infants. Studies are required to establish criteria for the diagnosis of clinical and sub clinical rickets, particularly in malnourished children. Prevention programs need to be pursued consistently and systematically and treatment options, including the single massive dose of vitamin D, need to be re-evaluated and optimal mode of treatment determined.

Background: Nutritional rickets is common among Ethiopian children. It contributes to infant mortality and morbidity and carries long-term consequences. Factors influencing caretaker behavior of exposing infants to sunshine, a simple preventive strategy, are not fully understood. Objectives: To measure the intention of Ethiopian mothers to expose their infants to sunshine and determine which of the Triandis variables (perceived consequences, affect, social factors) are associated with this behavioral intention of mothers. Methods: The study was conducted in the Ethio-Swedish Children Hospital in Addis Ababa in April 1999. It involved 378 mothers of children who were selected by systematic random sampling. A pre-tested, structured and pre-coded questionnaire consisting 8-items for each subscale of variables in the Triandis Model (intention = value of perceived consequences of behavior + affect toward behavior + social factors) and selected socio-demographic variables was used to collect data. Results: Perceived consequences, maternal marital status, and grand mothers role are independently and strongly associated (p < 0.001) with maternal intention. The final model explains 68%, a significant proportion (p < 0.0001), of the variability in intention. Maternal age, ethnicity, literacy level, employment status, and family size and income were not statistically significantly associated with this behavioral intention. Conclusions: More comprehensive epidemiological studies on social, cultural, and psychological determinants of this risk behavior among Ethiopian mothers will be required. In the meantime, data from the present study can be used in developing health messages to mothers in Addis Ababa and other urban areas in the country. [Ethiop. J. Health Dev. 2002;16(1):31-40]

Pneumonia, diarrhea, malaria, measles and malnutrition account for over 70% of the 11.5 million deaths and 80-90% of sick child consultations in developing countries. These conditions often occur in combinations requiring a holistic approach of assessment, treatment and caretaker counseling. The Integrated management of Childhood Illness (IMCI) strategy has been developed to address these needs. Ethiopia contributed immensely to the development of IMCI and officially adopted it in 1997. Progress in terms of training and geographic expansion has been limited. This analytical review has been made to identify ways to strengthen and sustain IMCI implementation. Data were collected from published and unpublished information sources relevant to the IMCI strategy in Ethiopia and through key informant interviews with representatives of Federal Ministry of Health and its partners. The rationale for IMCI in Ethiopia, past, present and planned IMCI activities, related policies and strategies, strengths and weaknesses, and priorities have been analyzed and recommendations developed. The review identified that most of the childhood deaths and 40% of all disability-adjusted life years lost are associated with pneumonia, diarrhea, malaria, measles and malnutrition. IMCI has, thus, been adopted in 1997 as the main strategy for improving child health and included in the Health Sector Development Programme of the country. Three regions have piloted the strategy and their experience used to develop plans for expansion to other regions and also to initiate IMCI activities related to family and community practices. Much has been learnt from the pilot phase and from the country's involvement in the initial development of the strategy. There are critical gaps that need to be addressed for the IMCI strategy to exert the desired impact on child health in Ethiopia. The HIV/AIDS algorithm should be validated and included in the IMCI guidelines. There is a need for scaling-up training activities and carry out follow-up after training in 4-6 weeks. A standardized checklist needs to be developed and integrated into existing supervision protocols and this be used to supervise IMCI implementing facilities regularly. Strategies to train and involve lower level health cadres in IMCI implementation and modify the standard IMCI course to suit senior physicians and programme managers are required. Standard recording and reporting tools need to be developed and IMCI classifications harmonized with current MOH guidelines. Essential IMCI drugs should be available to health facilities. Interventions need to be identified and tools developed to support the IMCI implementation at community and family level. Continued advocacy for IMCI is required to secure support from all stakeholders. Planning for IMCI should set clear milestones and take into consideration central and regional capacities and ways to strengthen them. Operations research is required to guide policy development and planning for IMCI implementation. It should be included as an essential activity in strategic and annual plans for IMCI implementation in Ethiopia.

Background : In Ethiopia, as most developing countries, there is little information on chronic suppurative otitis media (CSOM) in children. Awareness about the seriousness of the condition is limited among the caretakers. Treatment is largely empirical owing to lack of microbiological data. Objectives : The study was conducted to identify bacterial isolates associated with the chronic suppurative otitis media in children and determine their antibiotic susceptibility pattern. Methods : Children consecutively seen for chronic otitis media at Department of Pediatrics and Child Health of the Tikur Anbessa Hospital during January - May 2000 were included in the study. Clinical/demographic data were collected using in a pre-formed questionnaire. Ear swabs were collected, transported, and cultured using standards methods. Biochemical tests were used in identifying Gram-negative bacteria. All isolates were tested for their susceptibility to different antibiotics. Results : A total of 158 bacterial agents were isolated from 120 ear swabs collected from 112 patients aged between 3 months and 12 years. The most frequent isolates were Proteus species (31%), Staphylococcus aureus (18%), Escherichia coli (16%), Klebsiella species (12%), and Pseudomonas species (6%). Most of the isolates were resistant to commonly used antibiotics but sensitive to kanamycin (72%), augmentin (84%) and gentamycin (88%). Triple antibiotics resistance was most common resistance pattern. Conclusions : The high rate of multiple drug resistance, particularly to cheap and frequently used antibiotics, raises serious concern. More comprehensive studies are required to define the true magnitude of CSOM, to determine the microbiological profile of isolates and produce data for policy decision on optimal intervention modalities. (Ethiopian Journal of Health Development, 2001, 15(2): 89-96)

Within a multicenter study coordinated by WHO, an investigation of the etiologic agents of pneumonia, sepsis and meningitis was performed among infants younger than 3 months of age seen at the Ethio-Swedish Children's Hospital in Addis Ababa for a period of 2 years. Of the 816 infants enrolled 405 had clinical indications for investigation.There were a total of 41 isolates from blood cultures from 40 infants. The study showed that the traditionally known acute respiratory infection pathogen Streptococcus pneumoniae was most common in this extended neonatal age group, found in 10 of 41 blood isolates. Streptococcus pyogenes was a common pathogen in this setting (9 of 41 blood isolates), whereas Salmonella group B was found in 5 of 41 isolates. Streptococcus agalactiae, which is a common pathogen in developed countries, was absent. A study of the susceptibility pattern of these organisms suggests that a combination of ampicillin with an aminoglycoside is adequate for initial treatment of these serious bacterial infections, but the combination is not optimal for the treatment of Salmonella infections. Among 202 infants on whom immunofluorescent antibody studies for viruses were performed based on nasopharyngeal aspirates, respiratory syncytial virus was found in 57 (28%) infants, and Chlamydia trachomatis was isolated in 32 (15.8%) of 203 infants.

Pneumonia is the most important cause of morbidity and mortality in children aged under 5 years worldwide. Studies in developing countries have suggested an association between nutritional rickets and pneumonia. Since both nutritional rickets and pneumonia are common in Ethiopia, we did a case-control study to determine the role of nutritional rickets in the development of pneumonia.Cases were children younger than 5 years admitted to the Ethio-Swedish Children's Hospital during a 5-year period with a diagnosis of pneumonia (n = 521), but data were incomplete for 21 of these and they were not included. Controls (n = 500) were matched for admission within 3 months of cases and age within 3 months and had no evidence of pneumonia. Nutritional, demographic, and clinical and radiographic data for rickets and pneumonia were collected. Matched odd ratios and logistic regression were used to test the significance of the association of rickets and pneumonia.Rickets was present in 210 of 500 cases compared with 20 of 500 controls (odds ratio 22.11). There were significant differences between cases and controls for family size, birth order, crowding, and months of exclusive breastfeeding (p0.05). After correction for these confounding factors by logistic regression, there was still a 13-fold higher incidence of rickets among children with pneumonia than among controls (13.37 [95% CI 8.08-24.22], p0.001).Vitamin D or calcium deficiency may be important predisposing factors for pneumonia in children aged under 5 years in developing countries. Efforts to prevent vitamin D deficiency or calcium supplementation may result in significant reductions in morbidity and mortality from pneumonia in these children.

A review of 127 infants with haemorrhagic disease of the newborn (HDN) is presented. The case definition of HDN used in the selection of patients was bleeding during the 1st week of life in a newborn with normal platelet count, normal peripheral blood smear and complete clinical response to parenteral vitamin K. Equivocal cases with respect to cause of bleeding were excluded. The eligible cases consisted of 0.9% of all admissions to the unit and the male:female ratio was 1.8:1. Most were from families of low economic status and poor educational background. Omission of vitamin K prophylaxis and exclusive breastfeeding were the commonest antecedents. The mean (SE) gestation and admission weight were 39.3 (0.2) weeks and 2981 (78) g, respectively. One hundred and two (80.3%) had classical HDN with a mean (SE) age at onset of 63 (4.4) hours. Gastro-intestinal bleeding was the commonest observation. Thirty-three infants (26%) died, most of them from exsanguination. There is a need for well designed work to determine the magnitude of the problem, including that of late-onset HDN, the antecedent risk factors, the preferred route for administering prophylactic vitamin K and a clear policy guideline on prevention of the disease.