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The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study
Tigray Health Bureau, Tigray, Ethiopia;Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0003-2478-9598
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.ORCID iD: 0000-0001-5474-4361
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2019 (English)In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 31, no 10, p. 1271-1281Article in journal (Refereed) Published
Abstract [en]

Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

Place, publisher, year, edition, pages
Routledge, 2019. Vol. 31, no 10, p. 1271-1281
Keywords [en]
Ethiopia, HIV, PMTCT, health equity, under-5 morbidity, under-5 mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-158194DOI: 10.1080/09540121.2019.1601670ISI: 000471385300001PubMedID: 30957540Scopus ID: 2-s2.0-85063992477OAI: oai:DiVA.org:umu-158194DiVA, id: diva2:1305309
Funder
Swedish Research Council, C0615601Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2024-07-02Bibliographically approved
In thesis
1. Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
Open this publication in new window or tab >>Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att överbrygga klyftor inom barnhälsa för barn under fem år : En omfattande bedömning av deras sociala determinanter och hälsosystemets prestanda i Tigray, Etiopien
Abstract [en]

Background: Achieving the Sustainable Development targets related to child health necessitates a deep understanding of the multifaceted factors influencing their health.

Aim: To comprehensively examine the social determinants of the access to, and quality of, child health services, and the performance of the health system in the region of Tigray.

Methods: The study was conducted in six randomly selected rural districts of Tigray. The study employed focus group discussions and interviews (sub-study I), a retrospective case-control study (sub-study-II), a capture recapture method (sub-study III), and a two-stage mortality survey (sub-study IV).

Results: Sub-study I: underscored a good knowledge on the causes and management of common childhood morbidity, and that the health posts were conveniently located and provided trusted services. However, several barriers to using health services were identified. These included cultural beliefs, seasonal mobility, economic constraints, limited decision-making power for women, and accessibility challenges.Sub-study II: Revealed that only 76% of eligible children born to HIV-positive mothers were tested, with 17% testing positive for HIV, and only 29% of them linked to anti-retroviral treatment.Sub-study III showed that the concordance correlation coefficient between the Family Folder data and the household survey for the total population, reproductive age women, and under-five year child population were all above 0.73, while they were close to zero for other child health parameters. Tracing and recording neonatal deaths, and the aggregation of data at various levels were the major operational challanges.Sub-study IV identified infectious diseases (52.9%), neonatal causes (35.6%), nutritional disorders (6.6%) and external causes (4.3%) as the major causes of child death. The cause for 76 (16.2%) children was indeterminate. Tracing neonatal deaths and logistical challenges, especially in remote areas were the major operational issues of conducting the mortality survey.

Conclusion: In spite of the improvements in health literacy, access to cost-free reproductive, maternal, neonatal and child health services and improved utilization, various interrelated social determinants, including cultural beliefs, financial barriers and health system-related factors continue to hinder the optimal utilization of essential child health services. Moreover, the health system’s performance in the prevention of mother-to-child transmission of HIV and its effect in reducing mortality among exposed children is generally poor. Policymakers in the region should focus on tackling those social determinants, including the health system, to improve children´s health. The community health information system showed promising potential. However, the operational issue of capturing neonatal deaths adequately and the process by which community data can be aggregated upwards through the health system has to be improved. The study underscored the viability of implementing a cause-specific mortality survey using health extension workers, and the need to standardize data collection tools and logistics before implementation on a larger scale.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 94
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2307
Keywords
Under-five children, family folder, community, health information, verbal autopsy, health extension program, health system, Tigray, Ethiopia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224584 (URN)978-91-8070-404-5 (ISBN)978-91-8070-403-8 (ISBN)
Public defence
2024-08-30, NUS By 5B. plan 3, Umeå universitetssjukhus Rum Alicante, 09:00 (English)
Opponent
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Note

Paper III listed in thesis with title "Assessing the performance of the FF system for collecting community-based health information In Tigray Region, North Ethiopia: A capture-recapture study". Correct title of publication: Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study".

Available from: 2024-05-24 Created: 2024-05-20 Last updated: 2024-05-22Bibliographically approved

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Abraha, AtakeltiMyléus, AnnaByass, PeterKinsman, John

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