Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.

The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

Expanded Programme on Immunization

BACKGROUND Whether persistent low-level viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), to examine the association of pLLV and VF. METHODS NHS subjects who initiated combination antiretroviral therapy (ART) after 1996 were included if they had 2 or more VLs measured with a lower limit of detection of ≤50 copies/mL. VF was defined as a confirmed VL ≥200 copies/mL or any VL >1000 copies/mL. Participants were categorized into mutually exclusive virologic categories: intermittent LLV (iLLV) (VL of 50-199 copies/mL on <25% of measurements), pLLV (VL of 50-199 copies/mL on ≥25% of measurements), high-level viremia (hLV) (VL of 200-1000 copies/mL), and continuous suppression (all VL <50 copies/mL). Cox proportional hazards models were used to evaluate the association between VF and LLV; hazard ratios and 95% confidence interval (CI) are presented. RESULTS Two thousand six subjects (median age 29.2 years, 93% male, 41% black) were included; 383 subjects (19%) experienced VF. After adjusting for demographics, VL, CD4 counts, ART regimen, prior use of mono or dual antiretrovirals, and time to ART start, pLLV (3.46 [2.42-4.93]), and hLV (2.29 [1.78-2.96]) were associated with VF. Other factors associated with VF include black ethnicity (1.33 [1.06-1.68]) and antiretroviral use prior to ART (1.79 [1.34-2.38]). Older age at ART initiation (0.71 [0.61-0.82]) and non-nucleoside reverse transcriptase inhibitor (0.68 [0.51-0.90]) or integrase strand transfer inhibitor use (0.26 [0.13-0.53]) were protective. CONCLUSION Our data add to the body of evidence that suggests persistent LLV is associated with deleterious virologic consequences.

/pdf/persistent-low-level-viremia-while-on-antiretroviral-therapy-1lt679vx40.pdf

Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure

Despite the availability and improvement in diagnostic and therapeutic interventions with proven benefits in reducing cardiovascular morbidity and mortality, control rates of hypertension remain poor and grossly inadequate. Around one billion individuals are living with uncontrolled hypertension globally. Uncontrolled hypertension among hypertensive patients on treatment in Ethiopia ranges from 11.4 to 69.9%. Therefore, the aim of this study was to determine the magnitude and associated factors of uncontrolled hypertension among hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia 2018. Hospital-based cross-sectional study design was conducted from February 16–April 30/2018. Simple random sampling method was used to select 320 participants. Data was collected using interviewer administered standard structured questionnaire. Self-care practice measuring tool was adopted from hypertension self-care activity level effects (H-scale). Data was entered to and cleaned by Epi Info version 7 and it was exported to SPSS version 22 for analysis. Binary logistic regression model (AOR, 95% CI and p-value < 0.05) was used to determine the predictors of uncontrolled hypertension. From the total respondents, 164 (51.2%) were females. The mean age of the respondents was 53.83 + 14.52 years. Prevalence of uncontrolled hypertension was found 52.5%. Overweight (AOR = 4.527, 95% CI: 2.247–9.123), co-morbidity (AOR = 2.112, 95% CI: 1.218–3.662), non-adherence to anti-hypertensive medication (AOR = 2.062, 95% CI: 1.030–4.129), non-adherence to physical activity (AOR = 1.931, 95% CI: 1.074–3.470) and non-adherence to alcohol abstinence (AOR = 2.093, 95% CI: 1.109–3.948) are independent predictors of uncontrolled hypertension. the prevalence of uncontrolled hypertension is high. Patients’ adherence to antihypertensive medication, physical exercise and alcohol abstinence should be maximized. Weight reduction and early identification and management of co-morbidities are also crucial.

/pdf/uncontrolled-hypertension-and-associated-factors-among-adult-1g1fo7dozc.pdf

Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018.

Despite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia. A retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression. A total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of < 200 cells/micro liter (AOR = 1.33, 95%CI: 1.14, 1.54), recent CD-4 count of < 200 cells/micro liter (AOR = 3.78, 95%CI: 3.34, 4.27), regimen types: 1c (AZT-3TC-NVP) (AOR = 1.32, 95%CI: 1.22, 1.44), 2 h (TDF-3TC-ATV/R) (AOR = 1.79, 95%CI: 1.27, 2.52) and declined immunological responses after ART initiation (AOR = 1.45, 95%CI: 1.30, 1.61) were significantly associated with viral non-suppression. The virological non suppression was high which makes it less likely to achieve the third 90 UNAIDS target. Being male, patients with WHO staging II and poor ART adherence level were significantly associated with viral non suppression. Therefore, intensive adherence support and counseling should be provided. It is also a high time to determine the antiretroviral drugs resistance pattern given the fact that a large number of patients had virological non suppression.

/pdf/hiv-virological-non-suppression-and-factors-associated-with-prs4psn0af.pdf

HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study

Background 
Birth asphyxia, which accounts for 316% of all neonatal deaths, is one of the leading causes of such mortality in Ethiopia Early recognition and management of its contributing factors would modify the problem Thus, this study aimed to identify the determinants of birth asphyxia among live births at the University of Gondar Referral Hospital, northwest Ethiopia


Methods 
A hospital-based unmatched case-control study was conducted from April to July 2017Cases were newborn babies with an APGAR score of < 7at 5 minutes of birth; controls were newborn babies with an APGAR score of ≥7 at 5 minutes of birth Every other asphyxiated baby was selected as a case and every 6th non-asphyxiated baby as a control A pretested structured questionnaire was used to collect data on maternal sociodemographic characteristics A pretested structured checklist was used to retrieve data on ante-partum, intra-partum, and neonatal factors of both cases and controls Data were entered using Epi Info 7 and analyzed using SPSS 20 The bivariate logistic regression analysis was used to identify the relation of each independent variable to the outcome variable Variables with p values of up to 02 in the bivariate analysis were considered for the multiple logistic regression analysis An adjusted odds ratio (AOR) with a 95% CI and p-value of <005 was used to identify significant variables associated with birth asphyxia


Results 
In this study, prolonged labor (AOR = 275, 95% CI: 118, 694), cesarean section delivery (AOR = 358, 95% CI: 113, 1131), meconium stained amniotic fluid (AOR = 769, 95% CI: 299, 1770), fetal distress (AOR = 574, 95% CI: 153, 2155), and low birth weight (AOR = 772, 95% CI: 188, 3168) were factors which significantly increased the odds of birth asphyxia


Conclusion 
Prolonged labor, cesarean section (CS) delivery, meconium stained amniotic fluid (AF), fetal distress, and low birth weight were the determinants of birth asphyxia Thus, efforts should be made to improve the quality of intra-partum care services in order to prevent prolonged labor and fetal complications, and to identify and make a strict follow up on mothers with meconium stained amniotic fluid

/pdf/determinants-of-birth-asphyxia-among-live-birth-newborns-in-1zmqxw4c9u.pdf

Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study.

BACKGROUND Viral load monitoring is used as an important biomarker for diagnosing treatment failure in patients with HIV infection/AIDS. Ethiopia has started targeted viral load monitoring. However, factors leading to virological failure are not well understood and studied. Thus, the aim of this study was to identify the determinants of virological failure among HIV-infected patients on highly active antiretroviral therapy at the University of Gondar Referral Hospital, Northwest Ethiopia. METHODS A case-control study was conducted from May to June 2015. Cases were subjects who had already experienced virological failure; controls were those without virological failure. Data were extracted from 153 cases and 153 controls through chart review. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a p-value <0.05 were considered statistically significant. RESULTS In this study, higher odds of virological failure was observed among patients aged <35 years (adjusted odds ratio [AOR] =2.52, 95% CI: 1.33, 4.77), who had had CD4+ count <200 cells/mm3 (AOR=9.03, 95% CI: 4.40, 18.50), showed poor adherence to antiretroviral therapy (ART) (AOR=15.80, 95% CI: 6.90, 36.50), and had taken ART for longer durations of 25-47 months (AOR=3.00, 95% CI: 1.10, 8.40) and ≥48 months (AOR=6.70, 95% CI: 2.70, 16.60). CONCLUSION This study showed that patients aged <35 years and with recent low CD4 count, poor adherence to treatment, and longer exposure to ART were positively and significantly associated with virological treatment failure. Therefore, evidence-based intervention should be implemented to improve adherence to ART, which in turn helps to boost immunity (CD4) and suppresses viral replication and load. Moreover, attention should be given to younger patients who have had ART for longer periods.

/pdf/determinants-of-virological-failure-among-patients-on-highly-ufhvcdatts.pdf

Determinants of virological failure among patients on highly active antiretroviral therapy in University of Gondar Referral Hospital, Northwest Ethiopia: a case-control study.

Background Medication adherence is an important predictor of optimal blood pressure control; hence, it significantly reduces the risk of cardiovascular disease (CVD) and associated deaths. However, studies on medication adherence and its associated factors are scarce. Thus, this study aimed to assess adherence to antihypertensive medications and identify associated factors at Debre Tabor General Hospital, northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted. Simple random sampling technique was used to select 346 participants. A structured questionnaire adapted from the World Health Organization (WHO) STEPwise approach was used to collect data. Medication adherence was measured by the four-item Morisky-Green-Levine Scale, with a score ≥3 defined as "good adherence". Data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive and summary statistics were used. Bivariate and multivariable analyses were also carried out. Results A total of 337 hypertensive patients participated in the study. Three-quarters (75.1%) of the participants were found to be adherent to their medication therapy. The multivariable logistic regression analysis showed that urban residence (adjusted odd ratio [AOR]=2.10, 95% confidence interval [CI]: 1.15, 3.85), taking less than two drugs per day (AOR=3.04, 95% CI: 1.53, 6.06), and having knowledge about hypertension (HTN) and its treatment (AOR=8.86, 95% CI: 4.67, 16.82) were positively and significantly associated with medication adherence, while age >60 years (AOR=0.33, 95% CI: 0.11, 0.98) was negatively and significantly associated with good medication adherence. Conclusion A significant proportion of hypertensive patients poorly adhere to antihypertensive medications. Age, residence, pill burden, and knowledge about HTN and its treatment are important predictors of medication adherence. Attention should be given to increase the knowledge of patients about their disease and its treatment, and due emphasis should also be given to older and rural patients.

/pdf/medication-adherence-and-its-associated-factors-among-1lrsaakjhh.pdf

Medication adherence and its associated factors among hypertensive patients attending the Debre Tabor General Hospital, northwest Ethiopia.

Domestic violence during pregnancy with its many negative fetal and maternal outcomes is a common public health problem all over the world. Nonetheless, the problem is not well investigated and understood in Ethiopia. Hence, this study aimed to assess the prevalence of domestic violence and associated factors among pregnant women attending the University of Gondar Referral Hospital antenatal care (ANC) services. A hospital-based cross-sectional study was conducted from March–May 2016. A total of 450 pregnant women who visited the clinic were included in the study. A systematic random sampling technique was used to select study participants, and a pretested structured questionnaire was employed to collect data. The WHO multi-country study on women’s health and domestic violence against women was used to assess the violence against pregnant women. Descriptive statistics such as means, frequencies and percentages were computed. A multivariable logistic regression analysis was carried out to identify factors associated with domestic violence, and variables with p-values < 0.05 were considered as statistically significant. Of the total pregnant women surveyed, 58.7% were victims of at least one form of domestic violence during pregnancy, emotional violence being the most common (57.8%). The multivariable logistic regression analysis showed that house wives (adjusted odd ratio (AOR) = 3.43, 95% CI: 1.63, 7.21), women with no salary of their own (AOR = 3.37, 95% CI: 2.14, 7.95), partners’ daily use of alcohol (AOR = 4.59, 95%CI: 1.82, 11.56), women who believed in women’s rights to decide to be pregnant (AOR = 1.77, 95%CI: 1.18, 2.89), and women who disobeyed their partner (AOR = 2.36, 95%CI: 1.37, 4.07) were found to be positively and significantly associated with domestic violence during pregnancy. A high proportion of pregnant women experienced domestic violence during their pregnancy. Being a housewife, poor income status, partners’ use of alcohol, unwanted pregnancy, and disobeying of the women to their partner were factors associated with domestic violence during pregnancy. Evidence based female empowerment, especially the empowerment of women without income of their own, partner education and positive relations between partners are very important to minimize the problem.

/pdf/prevalence-of-domestic-violence-and-associated-factors-among-2ssm670kl7.pdf

Prevalence of domestic violence and associated factors among pregnant women attending antenatal care service at University of Gondar Referral Hospital, Northwest Ethiopia

Background Controlling blood pressure (BP) leads to significant reduction in cardiovascular risks and associated deaths. In Ethiopia, data is scarce about the level and determinants of optimal BP control among hypertensive patients. This study aimed to assess the prevalence and associated factors of optimal BP control among hypertensive patients attending at a district hospital. Methods A hospital-based, cross-sectional study was conducted among 392 hypertensive patients who were on treatment and follow-up at a district hospital. A structured questionnaire adopted from WHO approach was prepared to collect the data. Medication adherence was measured by the four-item Morisky Green Levine Scale, with a score ≥3 defined as “good adherence”. Blood pressure was measured, and optimal BP control was 0DEFined as systolic BP < 140 mmHg and diastolic BP<90 mmHg. Both binary and multivariable logistic regressions models were fitted to identify correlates of optimal BP control. All statistical tests were two-sided and a p values <0.05 was considered for statistical significance. Results The mean age of the participants was 58 years (SD±13 years). Over half (53.8%) were females. Three quarters (77.3%) of the participants were adherent to their medications. The overall proportion of participants with optimally controlled BP was 42.9%.Female sex (Adjusted Odd Ratio(AOR) = 1.94, 95% CI: 1.15, 3.26), age older than 60 years (AOR = 2.95, 95% CI: 1.18, 7.40), consumption of vegetables on most days of the week (AOR = 2.16, 95% CI: 1.25, 3.73), physical activity (AOR = 4.85, 95% CI: 2.39, 9.83), and taking less than three drugs per day (AOR = 3.04, 95% CI: 1.51, 6.14) were positively associated with optimally controlled BP. Poor adherence to medications (AOR = 0.18, 95% CI: 0.09, 0.35), having asthma comorbidity (AOR = 0.33, 95% CI:0.12, 0.88) and use of top added salt on a plate (AOR = 0.20, 95% CI:0.11, 0.36) were negatively associated with optimal BP control. Conclusion A higher proportion of hypertensive patients remain with un-controlled BP. Modifiable risk factors including poor adherence to medications, lack of physical exercise, adding salt into meals, being on multiple medications and comorbidities were significantly and independently associated with poor BP control. Evidence-based, adherence-enhancing and healthy life style interventions should be implemented.

/pdf/determinants-of-blood-pressure-control-amongst-hypertensive-2qt6161zvm.pdf

Destaw Fetene Teshome

Papers

Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study.

Determinants of virological failure among patients on highly active antiretroviral therapy in University of Gondar Referral Hospital, Northwest Ethiopia: a case-control study.

Medication adherence and its associated factors among hypertensive patients attending the Debre Tabor General Hospital, northwest Ethiopia.

Prevalence of domestic violence and associated factors among pregnant women attending antenatal care service at University of Gondar Referral Hospital, Northwest Ethiopia

Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia.