Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017-2018).
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ABSTRACT:
SUBMITTER: Gelibo T
PROVIDER: S-EPMC9491827 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
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Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017-2018).
Gelibo Terefe T Lulseged Sileshi S Eshetu Frehywot F Abdella Saro S Melaku Zenebe Z Ajiboye Solape S Demissie Minilik M Solmo Chelsea C Ahmed Jelaludin J Getaneh Yimam Y Kaydos-Daniels Susan C SC Abate Ebba E
PloS one 20220712 7
The design and evaluation of national HIV programs often rely on aggregated national data, which may obscure localized HIV epidemics. In Ethiopia, even though the national adult HIV prevalence has decreased, little information is available about local areas and subpopulations. To inform HIV prevention efforts for specific populations, we identified geographic locations and drivers of HIV transmission. We used data from adults aged 15-64 years who participated in the Ethiopian Population-based HI ...[more]
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Project description:IntroductionIn 2014, the Joint United Nations Programme on HIV/AIDS set an 'ambitious' 90-90-90 target for 2020. By 2016, there were disparities observed among countries in their progress towards the targets and some believed the targets were not achievable. In this report, we present the results of data from the Ethiopia Population-based HIV Impact Assessment survey analyzed to assess progress with the targets and associated factors.MethodsWe conducted a nationally representative survey in urban areas of Ethiopia. Socio-demographic and behavioural data were collected from consenting participants using a structured interview. HIV testing was done following the national HIV rapid testing algorithm and seropositivity confirmed using a supplemental laboratory assay. HIV viral suppression was considered if the viral load was <1,000 RNA copies/ml. Screening antiretroviral drugs was done for efavirenz, lopinavir, and tenofovir, which were in use during the survey period. In this analysis, we generated weighted descriptive statistics and used bivariate and logistic regression analysis to examine for associations. The 95% confidence interval was used to measure the precision of estimates and the significance level set at p<0.05.ResultsOf 19,136 eligible participants aged 15-64 years, 614 (3% [95% CI: 0.8-3.3]) were HIV-positive, of which 79.0% (95% CI: 4.7-82.7) were aware of their HIV status, and 97.1% (95% CI: 95.0-98.3 were on antiretroviral therapy, of which 87.6% (95% CI: 83.9-90.5) achieved viral load suppression. Awareness about HIV-positive status was significantly higher among females (aOR = 2.8 [95% CI: 1.38-5.51]), significantly increased with age, the odds being highest for those aged 55-64 years (aOR = 11.4 [95% CI: 2.52-51.79]) compared to those 15-24 years, and was significantly higher among those who used condom at last sex in the past 12 months (aOR = 5.1 [95% CI: 1.68-15.25]). Individuals with secondary education and above were more likely to have achieved viral suppression (aOR = 8.2 [95% CI: 1.82-37.07]) compared with those with no education.ConclusionEthiopia made encouraging progress towards the UNAIDS 90-90-90 targets. The country needs to intensify its efforts to achieve the targets. A particular focus is required to fill the gaps in knowledge of HIV-positive status to increase case identification among population groups such as males, the youth, and those with low education.
| S-EPMC8880883 | biostudies-literature
Project description:BackgroundThe 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.MethodsWe 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).ResultsWe 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.ConclusionOne-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.
| S-EPMC8357455 | biostudies-literature
Project description:BACKGROUND:Globally, by the end of 2018, 37.9 million people were living with human immunodeficiency virus (HIV). Sub-Saharan Africa carries the highest burden with an estimated 71% of the global total. In Ethiopia, an estimated 715 404 people were living with HIV in 2015 and this increased to 722 248 in 2017. This study was to explore the trends and spatial distributions of HIV cases in Ethiopia. METHODS:In this study, we explored the spatial and temporal distribution of persons living with HIV in Ethiopia using data from 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys (EDHS). Geographic information system (Getis-Ord Gi* statistics) and spatial scan statistics (SaTScan) were used for exploratory and confirmatory spatial analyses respectively. RESULTS:The overall prevalence of HIV in Ethiopia unveiled inconsistent trends, with the majority of areas showing decreasing trends. Hot spot clusters exhibited in all the three surveys, which include areas where Amhara, Afar and Tigray regions share neighbourhoods. In 2005 regionally, Gambella, Addis Ababa, and Harari had the highest prevalence at 6.0, 4.7 and 3.5%, respectively. While in the 2016 survey the highest prevalence (4.8%) was observed in Gambella regional state followed by Addis Ababa (3.4%). CONCLUSIONS:The distribution of HIV infection in Ethiopia is not random in all the three EDHS surveys. High clusters of HIV cases were consistently observed in Addis Ababa and neighbouring areas of the Afar Tigray and Amhara regional states and central Oromia. This analysis revealed that there are still areas which need studying with respect to the epidemic of HIV. In this regard Addis Ababa, certain areas of Amhara regional state, large areas of Afar region and central Oromia require special attention.
| S-EPMC6796490 | biostudies-literature
Project description:Alcohol consumption during pregnancy is a known contributor to teratogen and causes a range of effects on pregnancy and birth outcomes. This study aimed to investigate the spatial variation and determinants of alcohol consumption among pregnant women in Ethiopia. A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 1,135 pregnant women were included in the analysis. ArcGIS version 10.7 software was used to explore the spatial distribution of alcohol consumption, and SaTScan version 9.6 was employed to identify the significant spatial clusters of alcohol consumption. A mixed multi-level logistic regression analysis was employed to identify the determinant factors of alcohol consumption during pregnancy. The result showed that the prevalence of alcohol consumption during pregnancy was 22.49% (with a 95% CI: 18.18 to 26.17). The spatial analysis showed that the spatial distribution of alcohol consumption significantly varied across the country [Global Moran's I value = 0.30 (P<0.001)]. The SaTScan analysis identified two most likely clusters with high rates of alcohol consumption such as northwest Ethiopia (Log-Likelihood Ratio (LLR) = 155.56, p<0.001) and central Ethiopia (LLR = 19.27, p<0.01). Never in union, divorced and/ widowed [Adjusted odds ratio (AOR) = 2.56; 95% CI: 1.07, 10.14], attended primary school [AOR = 0.45; 95% CI: 0.27, 0.95], having two or more lifetime sexual partners [AOR = 2.59; 95% CI: 1.11, 6.18], living in rural [AOR = 1.52; 95% CI: 1.12, 2.93] and higher community media exposure [AOR = 0.54; 95% CI: 0.28, 0.97] were the factors associated with alcohol consumption. Alcohol consumption during pregnancy in Ethiopia was high. The spatial distribution of alcohol consumption was significantly varied across the country. Therefore, public health interventions targeting areas with high alcohol consumption are needed for drinking cessation and to prevent poor pregnancy outcomes related to alcohol use.
| S-EPMC9770435 | biostudies-literature
Project description:BackgroundMeasures of malaria burden using microscopy and rapid diagnostic tests (RDTs) in cross-sectional household surveys may incompletely describe the burden of malaria in low-transmission settings. This study describes the pattern of malaria transmission in Ethiopia using serological antibody estimates derived from a nationwide household survey completed in 2015.MethodsDried blood spot (DBS) samples were collected during the Ethiopian Malaria Indicator Survey in 2015 from malarious areas across Ethiopia. Samples were analysed using bead-based multiplex assays for IgG antibodies for six Plasmodium antigens: four human malaria species-specific merozoite surface protein-1 19kD antigens (MSP-1) and Apical Membrane Antigen-1 (AMA-1) for Plasmodium falciparum and Plasmodium vivax. Seroprevalence was estimated by age, elevation and region. The seroconversion rate was estimated using a reversible catalytic model fitted with maximum likelihood methods.ResultsOf the 10,278 DBS samples available, 93.6% (9622/10,278) had valid serological results. The mean age of participants was 15.8 years and 53.3% were female. National seroprevalence for antibodies to P. falciparum was 32.1% (95% confidence interval (CI) 29.8-34.4) and 25.0% (95% CI 22.7-27.3) to P. vivax. Estimated seroprevalences for Plasmodium malariae and Plasmodium ovale were 8.6% (95% CI 7.6-9.7) and 3.1% (95% CI 2.5-3.8), respectively. For P. falciparum seroprevalence estimates were significantly higher at lower elevations (< 2000 m) compared to higher (2000-2500 m) (aOR 4.4; p < 0.01). Among regions, P. falciparum seroprevalence ranged from 11.0% (95% CI 8.8-13.7) in Somali to 65.0% (95% CI 58.0-71.4) in Gambela Region and for P. vivax from 4.0% (95% CI 2.6-6.2) in Somali to 36.7% (95% CI 30.0-44.1) in Amhara Region. Models fitted to measure seroconversion rates showed variation nationally and by elevation, region, antigen type, and within species.ConclusionUsing multiplex serology assays, this study explored the cumulative malaria burden and regional dynamics of the four human malarias in Ethiopia. High malaria burden was observed in the northwest compared to the east. High transmission in the Gambela and Benishangul-Gumuz Regions and the neglected presence of P. malariae and P. ovale may require programmatic attention. The use of a multiplex assay for antibody detection in low transmission settings has the potential to act as a more sensitive biomarker.
| S-EPMC6647069 | biostudies-literature
Project description:A shift in focus towards healthy reproductive outcomes may reveal opportunities for novel interventions and strategies to promote optimal health. Using variables from the National Center for Health Statistics restricted use natality files, we calculated Empirical Bayes smoothed (EBS) rates of optimal birth for the all live births-both overall and by maternal race/ethnicity-by applying the smoothing tool in GeoDa version 1.18.0.10 We defined counties achieving greater racial birth equity as those where the overall EBS optimal birth rate was greater than the national 75th percentile and the absolute difference between maternal racial/ethnic categories was smaller than the national 25th percentile difference. During the study period, 49.80% of overall births could be classified as an optimal birth according to the study definition. Of the 3140 US counties, only 282 (8.98%) appeared to advance White-Black equity in optimal births, and 205 (6.53%) appeared to advance White-Hispanic equity in optimal births. In the effort improve maternal health, we should focus not only on the absence of negative outcomes, but also the occurrence of positive outcomes. Our analytic results suggest that optimal births can be measured and that geographic inequities by race occur.
| S-EPMC9529881 | biostudies-literature
Project description:While bacille-calmette-guerin (BCG) vaccination is one of the recommended strategies for preventing tuberculosis (TB), its coverage is low in several countries, including Ethiopia. This study investigated the spatial co-distribution and drivers of TB prevalence and low BCG coverage in Ethiopia. This ecological study was conducted using data from a national TB prevalence survey and the Ethiopian demographic and health survey (EDHS) to map the spatial co-distribution of BCG vaccination coverage and TB prevalence. A Bayesian geostatistical model was built to identify the drivers for the spatial distribution of TB prevalence and low BCG vaccination coverage. BCG vaccination coverage was defined as the number of children who received the vaccine divided by the total number of children born within five years preceding the EDHS surveys. Parameter estimation was done using binary logistic regression. Prediction maps for the co-distribution of high TB prevalence and low BCG vaccination coverage were created by overlying spatial prediction surfaces of the two outcomes. Posterior means and a 95% Bayesian credible interval (CrI) were used to summarize the parameters of the model. The national prevalence was 0.40% (95% confidence interval (CI) 0.34%, 0.47%) for TB and 47% (95% CI 46%, 48%) for vaccination coverage. Substantial spatial variation in TB prevalence and low BCG coverage was observed at a regional and local level, particularly in border areas of the country, including the Somali, Afar, and Oromia regions. Approximately 58% of the pixels (i.e., geographical area or spatial units) with high TB prevalence exhibited low BCG coverage in the same location. While travel time to cities (Mean = 0.28, 95% BCI: 0.15, 0.41) and distance to health facilities (Mean = 0.43, 95% CI 0.22, 0.63), were positively associated, population density (Mean = -0.04, 95% BCI -0.05, -0.02) was negatively associated, with the proportion of unvaccinated children for BCG indicating areas near health facilities and cities have better BCG coverage. However, there were no significant predictors for TB prevalence. Substantial spatial co-distribution between high TB prevalence and low BCG coverage was observed in some parts of the country, indicating that there are areas where the TB burden is not being adequately managed through the provision of vaccines in Ethiopia. Scaling up BCG vaccination coverage and TB diagnosis and treatment through improving access to health services in border regions such as Somalia and Afar would be important to reduce the prevalence of TB in Ethiopia.
| S-EPMC11685876 | biostudies-literature
Project description:BackgroundInstitutional delivery is an important indicator in monitoring the progress towards Sustainable Development Goal 3.1 to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Despite the international focus on reducing maternal mortality, progress has been low, particularly in Sub-Saharan Africa (SSA), with more than 295,000 mothers still dying during pregnancy and childbirth every year. Institutional delivery has been varied across and within the country. Therefore, this study aimed to investigate the individual and community level determinants, and spatial distribution of institutional delivery in Ethiopia.MethodsA secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 women was included in this study. For spatial analysis, ArcGIS version 10.6 statistical software was used to explore the spatial distribution of institutional delivery, and SaTScan version 9.6 software was used to identify significant hotspot areas of institutional delivery. For the determinants, a multilevel binary logistic regression analysis was fitted to take to account the hierarchical nature of EDHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p-values<0.2 in the bi-variable analysis were fitted in the multivariable multilevel model. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) were used to declare significant determinant of institutional delivery.ResultsThe spatial analysis showed that the spatial distribution of institutional delivery was significantly varied across the country [global Moran's I = 0.04 (p<0.05)]. The SaTScan analysis identified significant hotspot areas of poor institutional delivery in Harari, south Oromia and most parts of Somali regions. In the multivariable multilevel analysis; having 2-4 births (AOR = 0.48; 95% CI: 0.34-0.68) and >4 births (AOR = 0.48; 95% CI: 0.32-0.74), preceding birth interval ≥ 48 months (AOR = 1.51; 95% CI: 1.03-2.20), being poorer (AOR = 1.59; 95% CI: 1.10-2.30) and richest wealth status (AOR = 2.44; 95% CI: 1.54-3.87), having primary education (AOR = 1.47; 95% CI: 1.16-1.87), secondary and higher education (AOR = 3.44; 95% CI: 2.19-5.42), having 1-3 ANC visits (AOR = 3.88; 95% CI: 2.77-5.43) and >4 ANC visits (AOR = 6.53; 95% CI: 4.69-9.10) were significant individual-level determinants of institutional delivery while being living in Addis Ababa city (AOR = 3.13; 95% CI: 1.77-5.55), higher community media exposure (AOR = 2.01; 95% CI: 1.44-2.79) and being living in urban area (AOR = 4.70; 95% CI: 2.70-8.01) were significant community-level determinants of institutional delivery.ConclusionsInstitutional delivery was low in Ethiopia. The spatial distribution of institutional delivery was significantly varied across the country. Residence, region, maternal education, wealth status, ANC visit, preceding birth interval, and community media exposure were found to be significant determinants of institutional delivery. Therefore, public health interventions should be designed in the hotspot areas where institutional delivery was low to reduce maternal and newborn mortality by enhancing maternal education, ANC visit, and community media exposure.
| S-EPMC7660564 | biostudies-literature
Project description:BackgroundThe burden of malnutrition in children under five remains an important child health issue where significant regional variations are observed in Ethiopia. The main aim of the current study was to explore the spatial distribution of stunting, wasting, and underweight in children under five in Ethiopia.MethodsThe secondary data from EDHS, 2016, was employed, and a total of 7960 under-five children were included in the analysis. The general spatial analysis was performed to explore the spatial distribution of malnutrition among under-five within and between the regions of Ethiopia. The Spatial Lag and Spatial Error models were used to examine the spatial dependence between stunting, wasting, and being underweight. The Geographically weighted regression analysis was performed to estimate the types and strength of relationships between malnutrition and associated determinant factors across the regions and within the clusters or Zones of each region.ResultsAmong the under-five children included in the study, 36.6% were stunted, 12.2% were wasted and 25.2% were underweight. The Global Moran Index's value indicates (Stunting, I = 0.3135, p-value < 0.00001, Wasting, I = 0.1948, p-value < 0.0001 and Underweight, I = 0.5291, p-value < 0.0001) that there was a significant spatial variation of malnutrition across the regions and Zones of Ethiopia. The significant source of spatial variation of malnutrition in children under five was associated with the mother's education level, drinking water facility, toilet facilities, number of children under-five in the household, household's wealth index, breastfeeding duration of the child, child size at birth, Body Mass Index of Mothers (BMI), region, and place of residence.ConclusionsThe spatial association and spatial patterns of stunting, wasting, and being underweight were clustered within and between the regions of Ethiopia. The hotspot areas of stunting, wasting, and being underweight were detected in the regions where there were poor health facilities and limited socioeconomic indicators.
| S-EPMC10071774 | biostudies-literature
Project description:Gestational diabetes mellitus (GDM) has serious consequences for both maternal and neonatal health. The growing number of noncommunicable diseases and related risk factors as well as the introduction of new World Health Organization (WHO) diagnostic criteria for GDM are likely to impact the GDM prevalence in Bangladesh. Our study aimed to assess the national prevalence and identify the risk factors using the most recent WHO criteria. We used the secondary data of 272 pregnant women (weighted for sampling strategy) from the Bangladesh Demographic and Health Survey 2017-2018. Multivariate logistic regression was performed to determine the risk factors of GDM. The overall prevalence of GDM in Bangladesh was 35% (95/272). Increased odds of GDM were observed among women living in the urban areas (adjusted odds ratio (aOR) 2.74, 95% confidence interval (CI) 1.43-5.27) compared to rural areas and those aged ≥25 years (aOR 2.03, 95% CI 1.13-3.65). GDM rates were less prevalent in the later weeks of pregnancy compared to early weeks. Our study demonstrates that the national prevalence of GDM in Bangladesh is very high, which warrants immediate attention of policy makers, health practitioners, public health researchers, and the community. Context-specific and properly tailored interventions are needed for the prevention and early diagnosis of GDM.
| S-EPMC8909680 | biostudies-literature