The Institute of Public Health at the University of Gondar in partnership with Addis Continental Institute of Public Health is running its second year joint PhD program in Public Health. The second batch of PhD candidates will conduct their Dissertation Defense from June 02-03, 2014 at the University of Gondar.
Refer below to find out details about the candidates and their work.
Title of Dissertation: Spatiotemporal Distribution of Malaria in Highlands of Northwest Ethiopia
Paper I: Malaria Infection Has Spatial, Temporal, and Spatiotemporal Heterogeneity in Unstable Malaria Transmission Areas in Northwest Ethiopia. PLoS ONE 8(11): e79966.
Paper II: Bayesian Hierarchical Modeling towards Malaria Early Warning System Using Temperature and Rainfall. Under review malaria journal
Paper III: Men traveling away from home are more likely to bring malaria into high altitude villages, northwest Ethiopia. PLoS ONE 9(4): e95341
Paper IV: Spatiotemporal clusters of malaria cases at village level, northwest Ethiopia. Under review malaria journal
Background: In Ethiopia, two-thirds of the population lives in malaria transmission areas. Malaria transmission is highly heterogeneous by altitude and season, and transmission is vastly unpredictable in unstable highland areas; where frequent and often large-scale epidemics are observed due to the low immunity level of highland populations.
Objectives: The aim of the thesis was to identify patterns of malaria distribution by space and time in unstable malaria transmission district and village levels, determine factors which determine the risk of malaria transmission, and identify malaria anomalies using climate variables in northwest Ethiopia.
Methods: Routine data were retrieved for the period between 2003 and 2012 to identify the spatiotemporal patterns of malaria transmission and to forecast malaria transmission anomalies at district levels. To understand risk factors of malaria transmission and identify the spatiotemporal heterogeneity of malaria transmission at village levels, a case control study was conducted at health centers in high altitude areas. Either microscopy only or microscopy and rapid diagnostic tests together were used to confirm the presence of plasmodium species. The spatial data were created in ArcGIS10. The spatial scan statistics using the Poisson and Bernoulli method were used by applying Kulldorff methods using the SaTScan™ software to analyze the purely temporal, spatial and space-time clusters of malaria. The hierarchical generalized linear mixed model (GLMM) was implemented via Bayesian framework using Marcov Chain Monte Carlo (MCMC) methods for developing malaria alert system. The generalized linear model via Bernoulli model using Bayesian approaches and Marcov Chain Monte Carlo (MCMC) methods were used to identify predictors of malaria transmission.
Result: The study revealed that malaria case distribution has spatial, temporal, and spatiotemporal heterogeneity in unstable transmission areas. The likelihood of having spatial and spatiotemporal clusters in the same districts was high. Two malaria anomalies were detected retrospectively before initiation of malaria intervention 2003/1/1 to 2005/12/31 and after three to four years of the of initiation intervention. Monthly cumulative rainfall and monthly averaged maximum temperature with time lags of 1 to 3 months were found to be the most statistically significant to malaria risk. Travel away home, males and age older than fifteen years were important factors for malaria transmission at high altitude villages. Malaria clustered spatially and temporally at low endemicity of high altitude villages.
Conclusion and recommendation: Spatiotemporal clusters of malaria cases occur at district and village level. Travel outside of their home was an important risk of malaria infections acquisition for highlanders. Early warning malaria one to three months in advance based on temperature and rainfall anomalies can enhance the effectiveness of existing malaria surveillance and control systems, and facilitate timely response.
Title of Dissertation: Primary Health Services Utilization and Health Extension Program in North West Ethiopia
Paper I: Workplace conditions and organizational culture had positive association with job satisfaction of health extension workers in Ethiopia
Paper II: Health extension program factors, frequency of household visits and being model households, improved utilization of basic health services in Ethiopia. BMC Health Services Research 2014, 14:156
Paper III: The Community Based Health Extension Program significantly improved contraceptive utilization in West Gojjam Zone, Ethiopia. Journal of Multidisciplinary Health Care 2014, 7:1-8
Paper IV: The community based health extension program in Ethiopia significantly improved latrine utilization.
Background: Ethiopia has initiated a nationwide community health program known as Health Extension Program that is primarily staffed with health extension workers. The program requires highly satisfied health extension workers for successfully implementing it at grassroots level for better utilization of the program by the community. However the job satisfaction of health extension workers, the utilization of the program by the community, and the effects of the program on the community and related factors were not much studied. Therefore, the objective of this study was to assess the primary health services utilization and the HEP focusing on job satisfaction of health extension workers, utilization of health extension program and its effect on contraceptive and latrine utilzation.
Methods: The study utilized cross-sectional design. Data were collected from health extension workers using structured questionnaire containing questions related to values, organizational cultures, work place conditions, personality, and satisfaction items. Data were also collected from mothers aged 15 to 49 years using structured questionnaire for assessing the utilization health extension program by the community and its effect on contraceptive and latrine utilzation. A multiple linear regression model was used to identify predictors of satisfaction. A multilevel multivariate logistic regression was used to identify factors associated with utilization of the health extension program. Multivariate logistic regression and propensity score analysis were used to identify predictors of contraceptive and latrine utilization and determine the contribution of health extension program model households on contraceptive and latrine utilization, respectively.
Results: Health extension workers overall mean satisfaction score was 3.33 out of 5. They were dissatisfied with extrinsic factors with mean score of 2.89. Job satisfaction of health extension workers had a significant association with organizational culture (t-score = 2.115, p < 0.05), and workplace conditions (t-score = 7.607, p < 0.001). Mothers were more likely to use health post if they had frequent household visits by health extension workers (AOR = 1.29, 95% CI = 1.03 to1.83), were from model households (AOR = 2.15, 95% CI = 1.06 to 4.37), and had perceived understanding of the health extension program packages (AOR = 1.57, 95% CI = 1.06 to 2.34). Model households were 3.97 (AOR = 3.97; 95% CI = 3.01 to 5.23) and 2.39 (AOR = 2.39; 95% CI = 1.70 to 3.35) times more likely to utilize contraceptive and latrine respectively, compared to non-model households. Model households contributed 29.30% (t = 7.084) and 19.80% (t = 4.497) increase to contraceptive and latrine utilization respectively compared to non-model households.
Conclusion: The health extension workers were dissatisfied with extrinsic factors, such as the fringe benefits, educational and training opportunities, physical working conditions, pay and management which are critical elements for improving job satisfaction of HEWs if they are well addressed by decision makers and managers. Frequency of household visits by HEWs, number of years after graduation, and understanding the HEP were predictors of basic health services utilization. HEP model-households contributed significantly to contraceptive and latrine utilization. Thus, conducting continuous home visits of non-model households and following up the existing model households; and strengthening the information, education, and communication package are crucial in the implementation of the HEP to increase basic health services utilization.
Title of Dissertation: Epidemiology of Diabetes Mellitus and Barriers of Glycemic Control in Northwest Ethiopia
Paper I: Increasing trends of diabetes mellitus and body weight: a ten year observation at Gondar University teaching referral hospital, northwest Ethiopia. PloS one. 2013; 8(3): e60081.
Paper II: Diabetes mellitus in North West Ethiopia: a community based study. BMC public health. 2014; 14(1):97.
Paper III: Barriers to diabetes medication adherence in North West Ethiopia SpringerPlus 2014, 3:195
Paper IV: Poor glycemic control and associated factors among patients with diabetes mellitus in Ethiopia: A hospital based cross-sectional study
Background: Diabetes mellitus (DM) is recognized as one of the public health problems and the major cause of premature adult mortality in developing countries. In Ethiopia, lack of community-based data on the epidemiology of diabetes and incomplete routine health information on the treatment outcome of diabetic patients underestimates the burden of diabetes. This dissertation presents the epidemiology of diabetes and the barriers of poor glycemic control among persons with diabetes in Ethiopian.
Methods: To assess prevalence, a comparative cross-sectional population-based survey was performed using the WHO STEP-wise method among adults aged 35 years and older in rural and urban communities of Dabat and Gondar. A medical record of all registered persons with diabetes in the Diabetic Follow-up Clinic of Gondar University Hospital from 2001 – 2011 was included in the study. Patients with glycated hemoglobin tests (HbA1c) ≥7% were considered to check poor glycemic control. Adherence was assessed using the eight-item Morisky medication adherence scale. An Extended Mantel-Haenzel chi-square test for the linear trend was used to examine the trend over time and logistic regression (binary and ordinal logistic regressions) was used to check the association.
Results: The prevalence of diabetes mellitus was 5.1% among urban dwellers and 2.1 % among rural dwellers. The number of diabetes mellitus cases seen at Gondar Referral Hospital is rising steadily. The majority of the diabetic cases identified by the survey were not diagnosed prior to the survey, more so among the rural population. Findings revealed wide disparities between urban and rural populations in the distribution of the risk factors of diabetes. Family history of diabetes, old age, and physical inactivity were significantly associated with diabetes mellitus in the urban population. Moderate alcohol consumption was inversely associated with diabetes mellitus in the rural population. About two-third of the diabetic patients had poor glycemic control at the time of the study. Those who survived long with diabetes, diabetics that reported poor medication adherence, Type II diabetic patients receiving insulin treatment and no follow-up visits during the last six months, were more likely to have poor glycemic control. Type I diabetic patients with high Waist circumferences were less likely to have poor glycemic control. Poor wealth states, traditional medication use, noninsulin treatment among Type 2 diabetics and service dissatisfaction were important factors associated with low adherence.
Conclusion: The prevalence of diabetes mellitus is considerably high among the urban compared to the rural population, and it was largely undiagnosed and untreated, especially in the rural population. The prevalence of poor glycemic control is generally very high among diabetics in the follow-up care clinic. Over half of the diabetic patients are not adhering to medication. Overall prevention and treatment services for diabetics need to be better organized and made available widely at all levels of the health care system. Prevention, early identification and systematic follow up of treatment are the basic strategies for controlling DM.
Title of Dissertation: KHAT USE AMONG UNIVERSITY STUDENTS IN ETHIOPIA- the need to provide favorable study environment and alternative stress relieving activities
Paper II: Prevalence and predictors of harmful khat use among University students in Ethiopia
Paper III: University students with high level of stress are likely to use khat in Ethiopia
Dissertation SummaryBackground: The use of khat among students has been observed increasing in a recent decade. Students use khat mainly to help them study for long hours and to relieve stress. However limited studies are available in Ethiopia to show the extent of khat chewing practice and the factors associated with its use among Ethiopian University students. Because of concerns about mental and physical health consequences of prolonged and harmful use of khat that may affect students’ academic performance and well being it was imperative and timely to conduct this study.
Objectives: Tthe objective of this study was to determine the prevalence and harmful use of khat and its relationship with stress among Ethiopian University students.
Methods: A cross sectional study was conducted among Bahir Dar University regular undergraduate students in June 2012. Data were collected using a structured self-administered questionnaire. Logistic regression and ordinary logistic regression were done to identify factors associated with khat use.
Results: Prevalence of current khat chewing was 12.7% (95%CI: 11.5%, 13.9%) Male students are more likely to chew khat; Male: 14.9% (95%CI: 13.5%, 16.4%) as compared to Female: 4.8% (95%CI: 3.2%, 6.5%). The prevalence of harmful khat use was 2.6% (95%CI: 2.0%, 3.1%). All students except for four with harmful chewing habit were male. khat chewing practice was more likely among students who chew with non-students chewing friends [AOR= 5.73(95%CI: 91.56, 21.00)] and in those who simultaneous smoke cigarette [AOR = 2.91(95%CI: 1.23, 6.88). Khat use was less likely among students who regularly study in the library [AOR= 0.31(95%CI: 0.12, 0.8)] and those initiated khat chewing at age 18 year or older [AOR=0.36(0.15, 0.83)]. The prevalence of overall reported was: mild stress 34.7 % (95%CI: 32.9%, 36.5%) while 29.4% (95%CI: 37.7%, 31.3%) reported sever stress. Students who have reported higher level of stress were more likely to have perceived lack of privacy APOR= 2.79(95%CI: 1.81, 4.28) or had ever repeated a course APOR= 2.02 (95%CI: 1.34, 3.05. Students with higher level of reported stress were more likely to use khat.
Conclusions and recommendations: there is high prevalence of khat chewing, especially among male students among university students. The practice of khat chewing is highly affected by the peer groups in and outside campus. Khat is also used to relief stress by students making the two conditions interlinked. The universities need to work with relevant stakeholders to address khat chewing problems by providing students conducive environment for studying and alternative ways of relieving stress.
Key Words: college students, khat, stress, substance use
Title of Dissertation: Correlates of Sleep Quality among University Students in Ethiopia
Paper I: The Epidemiology of Sleep Quality, Sleep Patterns, Consumption of Caffeinated Beverages, and Khat Use among Ethiopian College Students. Sleep Disord. 2012; 2012: 583510.
Paper II: Sleep quality and its psychological correlates among university students in Ethiopia: a cross-sectional study. BMC Psychiatry 2012, 12:237
Paper III: Good quality sleep is associated with better academic performance among university students in Ethiopia. Sleep Breath. 2014;18(2):257-63
Paper IV: Sleep duration is associated with weight loss among College Students in Ethiopia – a finding different from that observed in the Western population
Background: Despite the growing prevalence of sleep deprivation and its correlates; few studies have been conducted in African settings and none have assessed this problem among university students in Ethiopia. Evidence from other parts of the world suggests, however, an increasing trend of sleep deprivation among university students and associated psychological, academic performance and other health related problems.
Objectives: The overall objective of this study is to understand the epidemiology of sleep and sleep deprivation and the psychological, behavioral, cognitive and physical health correlates of sleep problems among Ethiopian University students.
Methodology: The data come from a survey of university students in two public Universities of Ethiopia. A multi-stage sampling procedure was used to recruit study subjects. Data were collected from December 2010 to January 2011 using a structured self-administered questionnaire coupled with physical measurements. A mix of statistical including logistic regression, linear regression and multinomial logistic regression were applied as appropriate.
Result: More than 50% of the university students had poor sleep quality and more than 40% reported short sleep duration. Coffee and Caffeinated beverages and other stimulants were associated with sleep quality and its components. Students suffering from poor sleep quality were more likely to have psychological morbidities: anxiety, stress and depression. Poor academic performance was associated with poor sleep quality. Moreover, short sleep duration was not associated with weight gain but showed a statistically significant positive association with weight loss.
Conclusion: Inadequate sleep (sleep deprivation) is common among the university students, leading to day time dysfunction and psychological morbidities that hamper intellectual and scholarly achievements. Academic environment is the most common reported stressor among university students in different studies. Given the high prevalence of stress and other psychological morbidities in this study, it is possible that the students are living in a stressful environment which affects their sleep. Although they commonly use stimulants such as coffee to survive the academic burden, these too are affecting their sleep negatively. It is possible that students’ sleep might also be affected by their sleeping environment, as it was evidenced by the strong relationship between sleep quality and the university they were attending.
Recommendations: Appropriate counseling and guidance need to be facilitated by universities to avoid stimulants use and promote adequate and regular night sleep. Future research is needed to establish causality between the aforementioned factors and sleep parameters in the Ethiopian context. In addition, it is also important to explore environmental factors which could be modified at the institutional level.