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Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: a case control study.

ABSTRACT: Despite wide spread use of Antiretroviral Therapy (ART) by pregnant women living with Human Immunodeficiency Virus (HIV), the transmission rate is still higher by 18% after breastfeeding ends. The aim of this study was to identify factors affecting mother-to-child HIV transmission.Unmatched case-control study was conducted in Addis Ababa, from April to May, 2017. A case was HIV positive mother who had been on PMTCT program with her child confirmed HIV positive at or before 24 months and control was HIV positive mother who had been on PMTCT program with her child tested definitive HIV negative at 24 months. Accordingly, 44 cases were identified and for each case four controls with the nearest date of birth to the cases were selected from same health facilities. Primary data collected from the mothers were supplemented by record reviews and entered to Epidata version 3.1 and analyzed using SPSS version 22. Multivariate logistic regression was fitted to identify factors independently associated with mother-to-child HIV transmission.Lack of participation in mother-to-mother support program (AOR: 5.1; 95% CI: 1.4, 18.1), low partner involvement (AOR: 6.9; 95% CI: 1.4, 13.4), poor ART adherence (AOR:3.1; 95% CI: 1.3, 7.5), positive syphilis test results (AOR: 3.2; 95% CI: 1.2, 8.6), maternal malnutrition (AOR: 3.1; 95% CI: 1.4, 6.8), unplanned pregnancy (AOR: 10.3; 95% CI: 3.9, 27.2), home delivery (AOR: 5.3; 95% CI: 1.4, 19.4) and mixed feeding of the child during first six months of life (AOR: 12.5; 95% CI: 2.9, 52.7) were significantly associated with MTCT of HIV.Mother-to-mother support, male partner involvement in PMTCT of HIV, strengthening antenatal care, counseling mothers on appropriate infant feeding options are important to reduce mother -to- child transmission of HIV.

SUBMITTER: Beyene GA

PROVIDER: S-EPMC6045847 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: a case control study.

Beyene Girma Alemayehu GA Dadi Lelisa Sena LS Mogas Solomon Berhanu SB

BMC infectious diseases 20180713 1

<h4>Background</h4>Despite wide spread use of Antiretroviral Therapy (ART) by pregnant women living with Human Immunodeficiency Virus (HIV), the transmission rate is still higher by 18% after breastfeeding ends. The aim of this study was to identify factors affecting mother-to-child HIV transmission.<h4>Methods</h4>Unmatched case-control study was conducted in Addis Ababa, from April to May, 2017. A case was HIV positive mother who had been on PMTCT program with her child confirmed HIV positive ...[more]

PMID: 30005617

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Project description:About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.

Project description:Child sexual abuse is a significant public health concern and a breach of basic human rights affecting millions of children each year globally. It is typically not reported by victims, hence it remains usually concealed. Except for single studies with varying reports, there is no national studies conducted on child sexual abuse in Ethiopia. Therefore, this review determined the pooled magnitude and determinants of sexual abuse among children in Ethiopia. Potential articles were searched from PubMed, Science Direct, Scopus, and Web of science using relevant searching key terms. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the quality of all selected articles. Data were analyzed using STATA Version 14 software. Publication bias was checked using Egger's test and funnel plot. Cochran's chi-squared test and I2 values were used to assess heterogeneity. A random-effects model was applied during meta-analysis. The pooled prevalence of sexual abuse among 5,979 children in Ethiopia was 41.15% (95% CI: 24.44, 57.86). Sex of children (OR: 2.14, 95%CI: 1.12, 4.06), smoking (OR: 4.48, 95%CI: 1.26, 76.79), khat chewing (OR: 3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22, 10.25) were the determinants of child sexual abuse. The main perpetrators of sexual abuse against children were neighbors, boy/girlfriends, family members, school teachers, and stranger person. Child sexual abuse commonly took place in the victim's or perpetrator's home, school, and neighbor's home. This review revealed that the magnitude of child sexual abuse in Ethiopia was relatively high and multiple factors determined the likelihood of sexual violence against children. Thus, policy-makers and concerned stakeholders should strengthen comprehensive sexual and reproductive health education to reduce the magnitude and consequences of child sexual abuse. Moreover, support with special attention should be given to children with mental illness and physical disabilities.

Project description:BackgroundMeasuring household food insecurity in specific geographic areas provides vital information that enables appropriate and effective intervention measures to be taken. To that end, this study aimed to assess the prevalence of food insecurity and associated factors among Urban Productive Safety Net Program (UPSNP) beneficiary households in Addis Ababa, Ethiopia's capital city.MethodsA community-based cross-sectional study was conducted among 624 UPSNP beneficiary households in nine districts of Addis Ababa from June to July 2019. A multi-stage sampling method was used; study participants were selected using a simple random sampling technique after establishing the proportionally allocated sample size for 9 districts. Data were collected by trained personnel using a pretested, structured questionnaire. The outcome variable was food insecurity as measured by Household Food Insecurity Access Scale (HFIAS), a tool developed by the Food and Nutrition Technical Assistance Scale (FANTA) and validated for developing countries, including Ethiopia. A binary (crude odds ratio [COR]) and multivariable (adjusted odds ratio [AOR]) logistic regression analysis were employed at 95% CI (confidence interval). From the bivariate analysis, factors having a p-value<0.25 were included in the multivariable analysis. From the multivariable analysis, any variable at p-value < 0.05 at 95% CI was declared significantly associated with household food insecurity. Model fitness was also checked using the Hosmer-Lemeshow test with p-value>0.05.ResultsThe prevalence of household food insecurity was 77.1% [95%CI:73.8-80.7] during the month prior to the survey. Illiteracy of household head [AOR: 2.56; 95%CI:1.08-6.07], family size of 4 or more [AOR: 1.87, 95%CI:1.08-3.23], high dependency ratio [AOR: 3.95; 95%CI:1.31-11.90], household lack of access to credit [AOR:2.85; 95%CI:1.25-6.49], low household income [AOR: 4.72; 95%CI:2.32-9.60] and medium household income [AOR: 9.78; 95%CI:4.29-22.35] were significantly associated with household food insecurity.ConclusionWe found that three in four of Addis Ababa's UPSNP beneficiary households were food-insecure. Implementation of measures to improve household income, minimize the dependency ratio of households, and arrange access to credit services are paramount ways to tackle food insecurity problems in Addis Ababa.

Project description:BACKGROUND:Despite the presence of high impact interventions to improve infant and young child feeding, only about 52% of mothers in Ethiopia exclusively breastfeed their child for the first six months after delivery. Although the decision to breastfeed a child is ultimately that of the mother, this decision could be influenced by a variety of factors including social-cognitive ones. OBJECTIVES:The objectives of the study were to describe the breastfeeding behaviour of primiparous mothers during their prenatal period in terms of intentions/goals, outcome expectancies, self-efficacy, and socio-structural factors and assess their exclusive breastfeeding (EBF) practices as well as identify the social-cognitive predictors of EBF practices among these mothers in Addis Ababa, Ethiopia. METHODS:A prospective follow up health facility-based study with quantitative methods was used with a sample of 233 primiparous women. Both structured and semi-structured questions were used for collection of data. The Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis. Findings at the 95% confidence interval and P-value of 5% were reported as statistically significant. RESULTS:39.1% (n = 59) of the respondents were found to have high breastfeeding self-efficacy, 51.4% (n = 71) have good breastfeeding outcome expectancies, and 6.5% (n = 9) respondents had supportive breastfeeding socio-structural factors. Bivariate correlation analysis showed positive and statistically significant correlation between each of breastfeeding self-efficacy, outcome expectancy, and socio-structural factors, with EBF practice. However, only breastfeeding self-efficacy and outcome expectancies were statistically significant predictors of EBF among the primiparous women when controlling for confounding variables. CONCLUSIONS AND RECOMMENDATIONS:Health programmes aimed at improving EBF among primiparous mothers should look beyond providing health information alone. Rather improving primiparous women's breastfeeding self-efficacy and outcome expectancy is strongly recommended. Further community based large scale research is also recommended among similar groups of women.

Project description:BackgroundIn Ethiopia, malnutrition among older adults is under detected and, neglected area because the entire problem related with aging considered as fate of aging. Also, older adults are often omitted from public health research. Literatures are scarce in Ethiopia; there is limited information in the current study area among older adults using Min Nutritional Assessment (MNA). Therefore, this paper investigated the prevalence of malnutrition and its predictors among older adults people aged 65 years or above in Addis Ababa, Ethiopia.MethodsA community-based cross-sectional study was employed from January 1 to march 30, 2020 in Addis Ababa. Nutritional status of the older adults was measured by using Min nutritional assessment (MNA). Data from 662 older adults were collected through face to face interviews using a structured questionnaire. Bivariable and multivariable logistic regression analysis was done to identify factors associated with malnutrition.ResultThe prevalence of malnutrition among older adults was found to be 26.6%[95% Confidence interval (CI):22.8, 30.1]. Depression [Adjusted Odds Ratio (AOR) = 7.57 95%CI: 5.01, 11.45], being poor [AOR = 1.95 95% CI: 1.166, 3.25], occupation; daily laborer and guard [AOR = 2.78 95% CI: 1.12, 7.17] and being old old [AOR = 2.62 95% CI: 1.62, 4.25] were significantly associated with the higher odds of malnutrition.ConclusionThis study illustrated that considerably high proportion of older adults were malnourished in Addis Ababa. Socio-economic characteristics and depression were significantly associated with malnutrition. Therefore, nutritional and social support activities are essential for older adults, particularly of those who are socio-economically disadvantaged and advanced age. In addition, regular nutritional screening and management as well as behavioral interventions should be strengthened as a pillar component of therapeutic interventions. Specific nutritional requirements, at later stages of life is changing, and with the population aged over 65 years increasing in low-income countries like Ethiopia, the research in this field is likely to increase further.

Project description:Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

Project description:BackgroundPrevention of Mother-to-Child HIV Transmission (PMTCT) is still the most effective intervention in combating new HIV infections. In 2008, revised national PMTCT guidelines that incorporated new policies on HIV counselling and testing, antiretroviral prophylaxis regimen and infant HIV diagnosis came into effect in Ethiopia. In the present study we have examined trends in PMTCT service utilization and assessed the rate of MTCT in relation to policy changes in the national PMTCT programme.MethodsReports from February 2004 to August 2009 were reviewed in 10 sub-cities in Addis Ababa, Ethiopia. The data was collected from May to October 2009.ResultsThe proportion of women who received HIV counselling and testing among new antenatal care attendees increased from 50.7% (95% CI 50.2-51.2) in 2007 to 84.5% (95% CI 84.1-84.9) in 2009 following the shift to routine opt-out testing. Nevertheless, in 2009 only 53.7% of the positive women and 40.7% of their infants received antiretroviral prophylaxis. The HIV prevalence among antenatal attendees decreased significantly from 10.5% in 2004 to 4.6% in 2009 in parallel to the increased number of women being tested. The HIV positive women were over 18 times (RR 18.5, p < 0.0001) more likely to be referred for treatment, care and support in 2009 than in 2004. The proportion of partners tested for HIV decreased by 14% in 2009 compared to 2004, although the absolute number was increasing year by year. Only 10.6% (95% CI 9.9-11.2) of the HIV positive women completed their follow up to infant HIV testing. The cumulative probability of HIV infection among babies on single dose nevirapine regimen who were tested at >=18 months was 15.0% (95% CI 9.8-22.1) in 2007, whereas it was 8.2% (95% CI 5.55-11.97) among babies on Zidovudine regimen who were tested at >=45 days in 2009.ConclusionThe paper demonstrates trends in PMTCT service utilization in relation to changing policy. There is marked improvement in HIV counselling and testing service utilization, especially after the policy shift to routine opt-out testing. However, despite policy changes, the ARV prophylaxis uptake, the loss to follow up and the partner testing have remained unchanged across the years. This should be a matter of immediate concern and a topic for further research.

Project description:BackgroundThe life and health of street children is becoming a global concern. Street children are vulnerable to a variety of problems including physical, psychological and sexual exploitations as well as social isolation. Therefore, it was the purpose of this study to point out the experience of sexual and physical exploitation and its determinant factors among street children in Addis Ababa, the capital city of Ethiopia.MethodologyA phenomenological qualitative method was conducted from March to June 2016 in Addis Ababa, Ethiopia. Data were collected from street children by focus group discussion (FGD) and in-depth interview. Open code was used to analyze data. The transcribed note was translated. Following this coding was done. Based on a coding book, major themes and main categories were developed and analyzed.ResultThe study has explored the life experience of street children in the city. Deaths of parents/unhealthy relationship of extended families forced them be on a street. Thus, flee to street to search for work was the main reason for joining to a street. Street children are vulnerable to sexual and physical exploitations on a daily basis. For street children, street is the world characterized by misery deprivation, physical, verbal and sexual abuse and become daily victims of violence. There is no safe place for the children of on-street. Most street children are involved in all types of sex; heterosexual, bisexual, homosexual and group sex are common among themselves and out siders. They are involved highly in transactional sex for survival. Drug use, stress and depression are common experiences. Thus, they were socially isolated. The main challenges of living on a street are lack of basic needs, social isolation, lack of safety and security and being out of school are the common problems these vulnerable groups are facing.ConclusionsStreet children are at high risk of sexual and physical exploitation. Interventions targeting integration and reunion with families, reduction of physical and sexual exploitation, access to education, mental health promotion and reduction of drug use behavior should be taken in to considerations.

Project description:BackgroundThe health sectors success has been determined by consistent and reasonably priced health commodities supply. Despite possible death from the disease, Tuberculosis (TB) can be prevented with early diagnosis and appropriate treatment for which enough, effective, and qualified medicines need to be available. However, studies revealed stock of anti-TB drugs in health facilities. Here we present the recent finding on determinants of stock out of Anti-TB drug at public health facilities of Addis Ababa.ObjectiveThis study aimed to identify determinants of stock outs of first line anti TB drugs at public health facilities under Addis Ababa City Administration Health Bureau.MethodMixed study design were employed. A total of 106 facilities were included in the sampling frame and data were collected from the study population such as drug store managers of health facilities providing TB treatment using semi structured questionnaire and through in-depth interview with Addis Ababa hubs of the Ethiopian Pharmaceuticals Supply Agency (EPSA), Addis Ababa City Administration Health Bureau and selected heads of pharmacy departments of health facilities from May 1-30, 2020 considering one year back retrospective data from March 20,2019 to March 20,2020. Structured record review of data from Logistics Management Information System (LMIS) tools having TB drugs was done using structured observation checklist. Data were entered, cleaned, and analyzed using SPSS Version 20. Both descriptive and multiple logistic regression analysis were performed.Result52(62.7%) of health facilities encountered stock out for at least one of these drugs during the past 1 year. Rifampicin 75 mg + Isoniazid 50 mg (RH 75/50 mg) were most stocked out first line anti-TB drug from 33(39.8%) of facilities with 17 mean stocks out days while Rifampicin 75 mg + Isoniazid 50 mg + Pyrazinamide 150 mg (RHZ 75/50/150 mg) were the least first line anti-TB drug stocked out from facilities with mean 5 days of stock out. Delayed supply of anti TB drug from EPSA, delivery of reduced quantity of anti TB drugs by EPSA and stocked out of anti TB Drugs at EPSA were significant determinate factors of stock out of first line anti-TB drug from facilities with 95%CI of 10.34(2.167-49.329), 11.452(2.183-60.079) and 5.646(1.240-25.707) respectively.ConclusionAbove median of health facilities encountered stock out of first line anti-TB drug in Addis Ababa. Delayed supply of anti TB drug from EPSA, delivery of reduced quantity of anti TB drugs by EPSA and stocked out of anti TB Drugs at EPSA were significant determinate factor of stocked out of first line anti-TB drug from facilities. EPSA and other responsible bodies shall work collaboratively to improve their service and ensure availability of adequate amount of Anti TB drug in health facilities.

Project description:IntroductionDisclosure of HIV status to sexual partners can help HIV prevention efforts and enable HIV positive people to receive social support, as well as increasing access and adherence to treatment. This study was conducted to determine the rate, processes, outcomes, and correlates of HIV status disclosure to sexual partners among HIV positive individuals.MethodA cross-sectional study was conducted between September and November 2015 at two HIV outpatient clinics in Addis Ababa, Ethiopia. Data were collected using an interviewer- administered semi-structured questionnaire. Logistic analysis was used to determine the independent correlates of serostatus disclosure.ResultsOf 742 participants, (371 men and 371 women), 727 (98%) were on antiretroviral therapy and 676 (91.1%) had at least one sexual partner since their HIV diagnosis, of whom 558 (82.5%) had disclosed their HIV status to their most recent sexual partner. Of those who reported having disclosed their status to their most recent sexual partner, 82 (14.7%) had at least one unprotected sexual encounter with the partner, after HIV diagnosis but prior to disclosure. The most commonly reported initial outcome of disclosure was gaining emotional and/or financial support. Some (11.3%) also reported that their disclosure immediately initiated their partner for HIV testing. Negative outcomes to disclosure, such as stigma and discrimination, were more common among females (26.2%) compared to males (12.7%). In the multiple regression analysis, disclosure was associated with greater condom use, greater social support, knowing the partner's HIV status, having a good relationship with the partner, and cohabiting with the partner.ConclusionHIV disclosure was common amongst participants, although sometimes delayed, with possible consequences for onward transmission. Fear of negative outcomes, such as verbal abuse and physical violence, were major barriers to disclosure. Efforts to support disclosure have the potential to contribute to HIV control and prevention by encouraging safer sexual practice, initiating partners for HIV testing, and enhancing support for people living with HIV.

Dataset Information

Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: a case control study.

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Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: a case control study.

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