Public Health

In Ethiopia, it was shown that funding levels are far from compatible to the needs for care and support services for people living with human immuno-deficiency virus (PLHIV) and orphaned and vulnerable children (OVC). The aim in this study is to map the relationship between client needs, actors, care and support services provided for PLHIV and OVC in Ethiopia. A case study of the Ethiopian community care program was carried out using multiple methods of data collection as part of a multi-country research of four countries. Three program cases providing care and support services throughout the country were studied. A total of 35 in-depth interviews, 9 focus group discussions, 60 guided interviews, and 3 community mapping exercises were carried out. Analysis was conducted using the thematic framework approach with coding and mapping of the transcripts in the ATLAS.ti version 5.0. The expansion of antiretroviral therapy (ART) has reduced the number of bed-ridden PLHIV in need of home based nursing care. Currently, inadequate access to food and lack of income to cover health care and other expenses are the major concerns of PLHIV in Ethiopia. Community Home Based Care (CHBC) in Ethiopia can be categorised into two types; clinical and non-clinical. Non-clinical care (psychosocial, economic, home nursing care, material, food, and other social supports) is mainly provided by non-governmental care-giving organizations. Clinical care was provided mainly by government health facilities which comprised services such as early detection and treatment for opportunistic infections (OIs), ART services and PMTCT. A clear shift of the need of PLHIV from basic nursing care at home to social and material support needs was observed. A coordinated effort from the key players including governmental entities, non-governmental organizations (NGOs) and faith-based organizations (FBOs), the community, associations of PLHIV and volunteers is required to meet the current needs of PLHIV and OVC in the country.

Background: Worldwide, alcohol consumption caused 3.8 percent of all deaths and 4.5 percent of the total
burden of disease in 2004. Alcohol use disorders (AUDs) are also a burden for individuals and society in Ethiopia. It
is important to identify problematic alcohol use at an early stage, as this provides professionals with the opportunity
to take preventive measures and, hence, reduce the problems caused by this consumption. The high prevalence of
substance abuse problems among persons with psychiatric disorders calls for more effective alcohol and drug use
assessment in psychiatric settings.
Objectives: To assess prevalence of alcohol use disorders and its associated factors among psychiatric
outpatients in Jimma University specialized hospital (JUSH) Methods: A university hospital based cross-sectional
study of 365 psychiatric outpatients was conducted from 1st to 15th August 2013 in Jimma zone, south-west Ethiopia.
The data were collected by interviewing all psychiatric outpatients coming for treatment at JUSH by using structured
questionnaire. An alcohol use disorder was assessed using Alcohol Use Disorders Identification Test (AUDIT). All
variables associated with AUDs with a p value ≤ 0.25 were included in the final multivariable model.
Results: The estimated prevalence rate of AUD was 38.9%, with 23.3% hazardous drinking, 5.8% alcohol abuse
and 9.8% alcohol dependence. In the final multiple logistic regression model AUD was significantly associated with
Gender, Religion, Frequency of going to worship places and Cigarette smoking. Being female gender was less likely
to develop AUD. Those who were orthodox religion followers, those who never went to the worship places and those
who smoke cigarettes were more likely to have AUD.
Conclusions: The high prevalence of AUDs detected in our facility-based survey of psychiatric outpatients in
Ethiopia implies the need to design effective screening tools and feasible interventions for AUDs.

Improving access to health care services has been advocated widely since the Declaration of Alma-Ata. Despite the efforts to realize this in Ethiopia, it is only in the year 2003 that the intention to take the package of essential health services to the kebele level (smallest administrative unit) was realized through the introduction of the Health Services Extension Program (HSEP). The objective of this study was to explore whether introduction of HSEP has improved the coverage of child health services in the rural areas of Jimma Zone. A cross sectional study was conducted in three randomly selected districts of Jimma Zone, Southwest Ethiopia. The data collection was undertaken during the months of May, June and July, 2009. A structured questionnaire was used to interview female heads of sampled households from nine kebeles randomly selected in three Woredas (districts). Data were collected on the socio-demographic characteristics, use of health posts, child vaccination and childhood diarrhea. Checklists were used for record review. Data obtained were analysed using statistical package for social sciences (SPSS) V14. Only 64.0% of the kebeles had functional health posts, although another 32.0% of the kebeles in the zone had health posts under construction. However, most (93.7%) of the kebeles in the zone already had two health extension workers (HEWs) assigned. Vaccination coverage as measured by DPT3 was 67.9%, and 10% of the under-two year old children included in this survey had diarrhoea during the past two weeks. Of the 34 (51.5%) mothers who sought help during diarrhoeal attacks, 12 (35.3%) of them went to the health post. The first places of treatment seeking were health centres and health posts, with equal proportion for both (43.5%). Treatment was sought within a day or two after commencement of diarrhoea for 70.6% of the children. Thirty nine (69.7%) of the 56 children who were given recommended fluids received oral rehydration solution (ORS) or homemade solution. In addition to continuing efforts to improve coverage, there is a need to ensure that activities are linked with follow up of vaccination, early treatment seeking and proper home management of diarrhoea.

Background: Khat is an evergreen plant with leaves containing the amphetamine-like compounds cathinone and
cathine. Many people in the Horn of Africa use khat on a regular basis. Adverse health and social consequences of khat
use have been described but little is known about the use of khat in people living with Human Immunodeficiency
Virus (PLHIV) in Ethiopia. This study aimed to assess the prevalence of khat use and factors associated with khat
use among PLHIV who are in contact with HIV services in a hospital in south-west Ethiopia.
M e t h o d s : A cross-sectional study was conducted among 389 PLHIV who attended HIV services at Jimma University
Specialized Hospital in September 2012. A structured questionnaire, translated into the local languages, was used
to ask about the frequency of khat use and potential risk factors and consequences of khat use in this patient
group. Logistic regression analysis was used for bivariate and multivariable analysis.
R es u l t s : The overall prevalence of current khat use among people living with HIV was 23.0%. The prevalence was
18.3% in females and 33.6% in males. Christians were less likely to use khat when compared to Muslims (adjusted
Odds Ratio (aOR) 0.26, 95% CI = 0.13, 0.55). There was a positive association between khat use and mental distress
(aOR 1.84, 95% CI = 1.01, 3.36), smoking cigarettes (aOR 21.21, 95% CI = 7.19, 62.51), alcohol use disorders (aOR 2.16,
95% CI = 1.10, 4.21), CD4 count ≤200 cells/mm3 (aOR 3.46, 95% CI = 1.60, 7.50) and missing at least one dose of
antiretroviral medication in the preceding month (ART) (aOR 4.2, 95% CI = 1.80, 5.75).
C o n c lu s i o n : In this study there was a high prevalence of khat use among people living with HIV which was
associated with poorer adherence to ART. There is a need to adapt and evaluate feasible and acceptable
interventions to reduce khat use in people living with HIV.
Ke y w o r d s : Khat use, HIV, Mental distress, Ethiopia, ‘ART adherence’, Substance use disorder, Sub-Saharan Africa

Abstract Abstract
Introduction: - The HIV/AIDS epidemic has been truly global with 186 countries reporting HIV cases or deaths in 2012. More than 65 million people have been infected with HIV and 30 million people have died due to AIDS related causes since the emergence of AIDS in 1981. Because of impact of the rapid scale-up of ART in some countries with large epidemics there was decline in HIV/AIDS mortality and incidence. However, adherence to antiretroviral treatment (ART)  affected by factors like depression, substance abuse and treatment beliefs. Also treatment factors like regimen complexity, side effects and contextual factors are identified to affect ART adherence.  Nevertheless, nutritional and counseling intervention is efficient for increasing adherence to ART. Thus this systematic review will focus on some of the intervention like counseling, nutritional supplementation and material support to increase patients’ adherence to ART medication and clinical outcomes.
Objective: - The objective of this review is to determine the effectiveness of counseling, material support and/or nutritional supplementation on improving adherence to anti-retroviral therapy (ART) and clinical outcomes of patients
Methodology: - The review will consider studies that include HIV-positive patients aged 18 or more who have ever started taking ART drugs. This review will consider studies that include counseling, nutritional support and material support to improve adherence to ART medication.
Outcome of the study will be, adherence improved, clinical progression of HIV patients as measure by viral load, clinical staging and CD4 count
The databases to be searched include: MEDLINE and CINAHL. We will use Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix V) for the selected paper for retrieval

Abstract Abstract Introduction: - The HIV/AIDS epidemic has been truly global with 186 countries reporting HIV cases or deaths in 2012. More than 65 million people have been infected with HIV and 30 million people have died due to AIDS related causes since the emergence of AIDS in 1981. Because of impact of the rapid scale-up of ART in some countries with large epidemics there was decline in HIV/AIDS mortality and incidence. However, adherence to antiretroviral treatment (ART) affected by factors like depression, substance abuse and treatment beliefs. Also treatment factors like regimen complexity, side effects and contextual factors are identified to affect ART adherence. Nevertheless, nutritional and counseling intervention is efficient for increasing adherence to ART. Thus this systematic review will focus on some of the intervention like counseling, nutritional supplementation and material support to increase patients’ adherence to ART medication and clinical outcomes. Objective: - The objective of this review is to determine the effectiveness of counseling, material support and/or nutritional supplementation on improving adherence to anti-retroviral therapy (ART) and clinical outcomes of patients Methodology: - The review will consider studies that include HIV-positive patients aged 18 or more who have ever started taking ART drugs. This review will consider studies that include counseling, nutritional support and material support to improve adherence to ART medication. Outcome of the study will be, adherence improved, clinical progression of HIV patients as measure by viral load, clinical staging and CD4 count The databases to be searched include: MEDLINE and CINAHL. We will use Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix V) for the selected paper for retrieval