Showing papers by "Gail Davey published in 2008"

High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia

Abstract: The impact of public health interventions for tropical diseases is limited by lack of understanding of the sociocultural context into which these interventions are delivered. Podoconiosis (endemic non-filarial elephantiasis) is a considerable public health problem in Ethiopia, yet little is known about community understanding of it. This study aimed to assess the knowledge, attitudes and practices of community members towards podoconiosis in a highly endemic area in southern Ethiopia. A cross-sectional study was conducted in January 2007 among 438 study participants selected by multistage probability sampling. Most respondents (93.5%) had seen a patient with podoconiosis and 91.6% had heard of the local terms for podoconiosis. The proportion of respondents holding at least one misconception about causation was 93.4% (95% CI 91.1-95.7%). More than one-half (55.8%) showed stigmatising attitudes towards social interactions with podoconiosis patients and 63.8% had unfavourable attitudes towards the condition. Just over one-half (55.2%) of respondents were wearing shoes during the interview, but shoe wearing was inconsistent and inadequate to prevent podoconiosis. In this highly endemic area, the community held significant misconceptions about causation, care, treatment and prevention of podoconiosis. Community interventions for podoconiosis must include education components aimed at dispelling misconceptions and stigma.

Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis).

Abstract: OBJECTIVE To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. METHODS We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high-podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1-week repeatability and the inter-observer agreement of the final staging system. RESULTS The five-stage system is readily understood by community workers with little health training. Kappa for 1-week repeatability was 0.88 (95% CI 0.80-0.96), for agreement between health professionals was 0.71 (95% CI 0.60-0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52-0.78). CONCLUSIONS This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.

Status epilepticus: Clinical presentation, cause, outcome, and predictors of death in 119 Ethiopian patients

Abstract: Summary Purpose: Status epilepticus (SE) is a common neurological emergency with high morbidity and mortality. There is no study that has been conducted among Ethiopian patients with SE. The purpose of this study was to analyze clinical presentation, causes, complications, outcomes, and predictors of mortality. Methods: In this retrospective study, patients aged ≥13 year with SE were included. Medical records were reviewed and demographic and clinical data were collected. Results: Records of 119 patients were analyzed; preexisting epilepsy was found in 38.7%. Primarily generalized and focal with secondarily generalized (FWSG) seizures were identified in 60.5% and 36%, respectively. Simple partial SE occurred in 3.4%. Central nervous system (CNS) infection was the most common cause of SE in the whole group as well as in those with new onset seizure. Antiepileptic drug withdrawal (AEDW) was the main cause in those with preexisting seizure. One or more complications were detected in 61%. Intravenous diazepam and oral phenytoin were given to 95% and 97.5%, respectively. Case fatality was 20.2%; poor outcome occurred in 24%. Predictors of mortality were FWSG type, acute symptomatic etiology, stroke, systemic infection, and HIV/AIDS and its CNS complications. Idiopathic and SE due to AEDW were associated with good prognosis. Conclusions: CNS infection was the most common cause of SE in the whole group and AEDW was the major cause in patients with preexisting epilepsy. Parenteral anticonvulsants, emergency measurement of serum AED level, and electroencephalography for urgent diagnosis and monitoring were unavailable. Mortality was related to underlying etiologies especially HIV/AIDS and its CNS complications.

FULL-LENGTH ORIGINAL RESEARCH Status epilepticus: Clinical presentation, cause, outcome, and predictors of death in 119 Ethiopian patients

Abstract: SUMMARY Purpose: Status epilepticus (SE) is a common neurological emergency with high morbidity and mortality. There is no study that has been conducted among Ethiopian patients with SE. The purpose of this study was to analyze clinical presentation, causes, complications, outcomes, and predictors of mortality. Methods: In this retrospective study, patients aged ≥13 year with SE were included. Medical records were reviewed and demographic and clinical data were collected. Results: Records of 119 patients were analyzed; preexisting epilepsy was found in 38.7%. Primarily generalized and focal with secondarily generalized (FWSG) seizures were identified in 60.5% and 36%, respectively. Simple partial SE occurred in 3.4%. Central nervous system (CNS) infection was the most common cause of SE in the whole group as well as in those with new onset seizure. Antiepileptic drug withdrawal (AEDW) was the main cause in those with preexisting seizure. One or more complications were detected in 61%. Intravenous diazepam and oral phenytoin were given to 95% and 97.5%, respectively. Case fatality was 20.2%; poor outcome occurred in 24%. Predictors of mortality were FWSG type, acute symptomatic etiology, stroke, systemic infection, and HIV/AIDS and its CNS complications. Idiopathic and SE due to AEDW were associated with good prognosis. Conclusions: CNS infection was the most common cause of SE in the whole group and AEDW was the major cause in patients with preexisting epilepsy. Parenteral anticonvulsants, emergency measurement of serum AED level, and electroencephalography for urgent diagnosis and monitoring were unavailable. Mortality was related to underlying etiologies especially HIV/AIDS and its CNS complications.

Validation of the Dermatology Life Quality Index among patients with podoconiosis in southern Ethiopia.

Abstract: BACKGROUND Podoconiosis is a geochemical elephantiasis common among subsistence farmers in Ethiopia. It is completely preventable but, untreated, leads to considerable physical disability, social stigma and economic disadvantage. Quality of life has to date not been assessed among patients with podoconiosis. OBJECTIVES We aimed to assess the feasibility, internal consistency and concurrent validity of an Amharic translation of the Cardiff Dermatology Life Quality Index (DLQI) among patients with podoconiosis in southern Ethiopia. METHODS We performed a comparative cross-sectional study among 74 new patients and 74 patients treated for at least 3 months at outreach clinics of the Mossy Foot Treatment and Prevention Association, a nongovernment organization providing services for more than 30,000 patients annually in southern Ethiopia. RESULTS The DLQI was quick and simple to use, taking on average 4 min to administer. It distinguished successfully between new and treated patients (median scores 13 vs. 3, P < 0.001). The inter-item correlation averaged 0.44, and Cronbach's alpha was 0.90, indicating high internal consistency. The mean DLQI score for all patients was 8.42, and the highest score was for item 2 (feeling self-conscious). The item with the highest score among new patients was item 1 (pain), while that among treated patients was item 4 (clothes choice). CONCLUSIONS The Amharic DLQI appears feasible, reliable and valid among patients with podoconiosis in southern Ethiopia. The DLQI will play an important role in assessing the physical and social interventions available locally and in guiding the roll-out of these interventions to much larger groups of patients throughout Ethiopia.

The economic impact of HIV/AIDS morbidity and mortality on households in Addis Ababa, Ethiopia

Abstract: The present study investigates whether the household-level economic impact of an adult AIDS death is different from that of death from another cause. The data come from cross-sectional post-mortem interviews (verbal autopsies) with relatives or primary caregivers of deceased adults randomly selected from deaths recorded in an ongoing burial surveillance in Addis Ababa. Our analyses consist of three parts. First, we assess the sociodemographic risk factors for AIDS mortality. Subsequently, we reverse the causal order of this relationship and carry out an analysis of the effect of AIDS mortality on the subjective experience of change in the household's financial situation following the death of a household member. Finally, we quantify the direct and indirect costs of illness and death on the household. Results indicate that households experiencing an HIV/AIDS death are poorer than those experiencing a non-HIV/AIDS death. In addition, poorer households experience a greater decline in socioeconomic status following death of a household member. AIDS mortality has more detrimental effects on the household economic status than deaths due to other causes. While the difference between AIDS and non-AIDS mortality in terms of direct costs is minimal, the indirect cost of an AIDS death per household exceeds that of non-AIDS death by 58%. In conclusion, poor households are more likely to experience an AIDS death and in turn are more vulnerable to the socioeconomic impact of death. Therefore, it is justifiable to target HIV-impact mitigation programs on poorer households.

Which factors influence North Ethiopian adults' use of dual protection from unintended pregnancy and HIV/AIDS?

Abstract: Background: In Ethiopia 16.2% of births are not wanted, 18.7% of births are mistimed, and >90% of adult cases of HIV are attributable to heterosexual activity. Dual protection is an important public health intervention in this context. Objective: To assess the extent and predictors of dual protection among married or cohabiting people in Northern Ethiopia. Methodology: A community-based stratified cross-sectional survey of 868 married or cohabiting women and men, and four focus group discussions, were conducted in Adwa town, northern Ethiopia, in 2006. Results: 13.8% of respondents practiced effective dual protection. Predictors included male sex, being literate, being employed, approval of condom use within marriage, and discussion of dual protection. Focus group participants emphasized the negative community perceptions associated with condom use within marriage. Conclusion: Use of dual protection was unusual in this North Ethiopian town. Condom use was uncommon among current hormonal contraceptive users, and condom use within marriage was highly stigmatized. [Ethiop.J.Health Dev. 2008;22(3):226-231]

Genomics research in Africa: implications for disease diagnosis, treatment and drug development: proceedings of the 5th annual meeting of the African Society of Human Genetics

Abstract: This paper presents the proceedings of the 5th Annual Meeting of the African Society of Human Genetics, which took place in Cairo, Egypt, on 3rd-5th November 2007. The meeting provided a much needed forum for the development of research networks and collaborations for all who are interested in the field of ‘genetics in Africa’ in its broadest sense. The meeting also presented an opportunity for the Society to debate the major issues in the field and to develop a long term strategy towards achieving the goals of the Society. The most exciting and ambitious outcome of the meeting was the launch of the African Genome Project. The meeting was held in conjunction with the First Annual Meeting of the Division of Human Genetics and Genome Research and the National Society of Human Genetics of Egypt. The conference theme was ‘Genomics Research in Africa: Implications for Disease Diagnosis, Treatment and Drug Development’. Over 200 participants (including clinicians, geneticists, statisticians, bioinformaticians and social scientists) attended from 28 countries, 16 of which are in Africa.