Impact of COVID-19 on non-communicable disease management services at selected government health centers in Addis Ababa, Ethiopia

Background

The global pandemic of COVID-19 forced the world to divert resources and asked the public to shelter-in-place, so the diagnosis surveillance system and management of non-communicable diseases has become more challenging.

Objective

To identify the impact of COVID-19 on non-communicable diseases management services at government health centers in Addis Ababa, Ethiopia.

Methods

Health facility based cross-sectional study was conducted from August to September, 2020. A total of 30 health centers were included in this study. Bivariate and multiple logistic regression models were used to assess association between the outcome and independent variables.

Results

The majority, 24 (80%), of the study participants perceived that the COVID-19 pandemic severely disrupted the non-communicable disease management services. There was a statistically significant association between a decrease in outpatient volume at non communicable disease (NCD) management services (25 (83.3%), P-value: 0.006), closure of population level screening programs of NCDs (22 (73.3%), P-value: 0.007), and closure of disease specific NCD clinics and the occurrence of the COVID-19 pandemic (23 (76.7%), P-value: 0.013).

Conclusion

The most critical health-care services for non-communicable diseases management were severely disrupted by the COVID-19 pandemic. Therefore, during public health emergencies, policymakers should ensure continuation of critical clinical services and inform the public about proper service utilization.

Use of modified composite index of anthropometric failure and MUAC-for-age to assess prevalence of malnutrition among school-age children and adolescents involved in the school feeding program in Addis Ababa, Ethiopia

Background

Malnutrition hampers educational performance of schoolchildren coming from low-income families. School feeding program was, thus, launched in public primary schools in Addis Ababa very recently. It is, thus, important to measure the initial nutritional status of participating students to see the effect of the program on their nutritional wellbeing.

Methods

The first-round survey was made at the initiation of the program. A multi-stage stratified sampling from 50 schools located in the ten sub cities of Addis Ababa yielded 4500 children and adolescents of ages five to 19 years. Data was collected on age, height, weight and MUAC of the schoolchildren. Nutritional status was evaluated using conventional anthropometric indicators, modified Composite Index of Anthropometric Failure (mCIAF), and MUAC-for-age. Receiver Operating Characteristic (ROC) curve was used to examine classification of malnourishment by MUAC-for-age versus BMI-for-age and mCIAF versus MUAC-for-age. Multilevel mixed effects model was applied to investigate variations in the prevalence of malnutrition across sub cities.

Findings

The area under the ROC curves (AUC) for MUAC-for-age against BMI-for-age z-scores was 0.68 and that of mCIAF against MUAC-for-age was 0.70, respectively, indicating an overall better classification of malnourishment. Mixed effects model showed significant variations in nutritional status of schoolchildren across sub cities. Conventional measures showed that prevalence of stunting, thinness, or underweight among the sample children and adolescents was 23.4, 18.4, and 16.5%, respectively. Assessment by mCIAF, instead, showed a higher prevalence of overall malnutrition (43.4%). MUAC-for-age indicated an acute malnutrition measurement of 33.4%. Significant differences (p < 0.0001) in nutritional status were seen between boys and girls, and among age groups as measured by mCIAF.

Interpretation

Conventional measures of nutritional status undermined level of malnutrition. Instead, mCIAF and MUAC-for-age gave higher estimates of the magnitude of the existing prevalence of malnutrition among the school children and adolescents.

Baseline malaria prevalence at the targeted pre-elimination districts in Ethiopia

Background

Encouraged by the previous success in malaria control and prevention strategies, the Ethiopian ministry of health launched malaria elimination with a stepwise approach by primarily targeting the low-transmission Districts and their adjacent areas/zones in order to shrink the country’s malaria map progressively. Hence, this community survey was conducted to establish baseline malaria information at the preliminary phase of elimination at targeted settings.

Methods

A community-based cross-sectional survey was conducted at 20 malaria-elimination targeted Districts selected from five Regional states and one city administration in Ethiopia. The GPS-enabled smartphones programmed with Open Data Kit were used to enumerate 9326 study households and collect data from 29,993 residents. CareStart™ Malaria PAN (pLDH) Rapid Diagnostic Tests (RDTs) were used for blood testing at the field level. Armpit digital thermometers were used to measure axillary temperature.

Result

Overall malaria prevalence by RDTs was 1.17% (339/28973). The prevalence at District levels ranged from 0.0 to 4.7%. The proportion of symptomatic cases (axillary temperature > 37.5^oc) in the survey was 9.2% (2760/29993). Among the 2510 symptomatic individuals tested with RDTs, only 3.35% (84/2510) were malaria positive. The 75.2% (255/339) of all malaria positives were asymptomatic. Of the total asymptomatic malaria cases, 10.2% (26/255) were under-five children and 89.8% (229/255) were above 5 years of age.

Conclusion

The study shows a decrease in malaria prevalence compared to the reports of previous malaria indicator surveys in the country. The finding can be used as a baseline for measuring the achievement of ongoing malaria elimination efforts. Particularly, the high prevalence of asymptomatic individuals (0.88%) in these transmission settings indicates there may be sustaining hidden transmission. Therefore, active case detection with more sensitive diagnostic techniques is suggested to know more real magnitude of residual malaria in the elimination-targeted areas.

The burden of cardiovascular diseases in Ethiopia from 1990 to 2017: evidence from the Global Burden of Disease Study

In Ethiopia, evidence on the national burden of cardiovascular diseases (CVDs) is limited. To address this gap, this systematic analysis estimated the burden of CVDs in Ethiopia using the Global Burden of Disease (GBD) 2017 study data. The age-standardized CVD prevalence, disability-adjusted life years (DALYs) and mortality rates in Ethiopia were 5534 (95% uncertainty interval [UI] 5310.09 - 5774.0), 3549.6 (95% UI 3229.0 - 3911.9) and 182.63 (95% UI 165.49 - 203.9) per 100 000 population, respectively. Compared with 1990, the age-standardized CVD prevalence rate in 2017 showed no change. But significant reductions were observed in CVD mortality (54.7%), CVD DALYs (57.7%) and all-cause mortality (53.4%). The top three prevalent CVDs were ischaemic heart disease, rheumatic heart disease and stroke in descending order. The reduction in the mortality rate due to CVDs is slower than for communicable, maternal, neonatal and nutritional disease mortalities. As a result, CVDs are the leading cause of mortality in Ethiopia. These findings urge Ethiopia to consider CVDs as a priority public health problem.

The burden of injuries in Ethiopia from 1990-2017: evidence from the global burden of disease study

Background

Mortality caused by injuries is increasing and becoming a significant global public health concern. Limited evidence from Ethiopia on road traffic, unintentional and intentional injuries indicate the potential public health impact of problems resulting from such injuries. However, there is a significant evidence gap about the actual national burden of all injuries in Ethiopia. This data base study aimed to reveal the national burden of different injuries in Ethiopia.

Methodology

Data for this study were extracted from the estimates of the Global Burden of Diseases (GBD) 2017 study. Estimates of metrics such as Disability-Adjusted Life Years (DALYs), death rates, incidence, and prevalence were extracted. The metrics were then examined at different injury types, socio-demographic categories such as age groups and sex. Trends of the metrics were also explored for these categories across years from 2007 to 2017. The DALYs and deaths due to injuries in Ethiopia were also compared with other East African countries (specifically Kenya, Tanzania, Uganda, and Zambia) in order to evaluate regional differences across years, by sex and by different injury types such as transport injuries, unintentional injuries, self-harm and interpersonal violence.

Results

The age-standardized injury death rate has decreased to 69.4; 95% UI: (63.0–76.9) from 90.11; 95% UI: (82.41–97.73) in 2017 as compared with 2007. Road injury, falls, self-harm and interpersonal violence were the leading causes of mortality from injuries occurring in 2017. The age-standardized injury DALYs rate has decreased to 3328.2; 95% UI: (2981.7-3707.8) from 4265.55; 95% UI: (3898.11–4673.64) in 2017 as compared with 2007. The number of deaths resulting from injuries in 2017 was highest for males, children under 5 years, people aged 15–24.

Conclusion

The current age-standardized death rate and DALYs from injuries is high and the observed annual reduction is not satisfactory. There is a difference in gender and age regarding the number of deaths resulting from injuries. The data indicates that the current national efforts to address the public health impact of injuries in Ethiopia are not sufficient enough to bring a marked reduction. As a result, a more holistic approach to address all injuries is recommended in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-020-00292-9.