Background: Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLH... more Background: Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa. Methods: Across-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization's Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol ('alcohol use disorders'). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value <0.25 were included in the final multivariable model. Results: The overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respectively. There was no significant difference in the prevalence of AUDs in persons receiving antiretroviral treatment compared to those who were antiretroviral therapy naïve (32.6% vs. 38.6%). AUDs were identified in 26.0% and 44.1% of females and males, respectively. Male gender, smoking cigarettes and psychological distress were positively associated independently with AUDs.
Child and Adolescent Psychiatry and Mental Health, 2015
Parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception and awareness about psychiatr... more Parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception and awareness about psychiatric illness in children and adolescents is an important determinant of early detection and treatment seeking for the condition. However, there has been limited information about the perception and awareness of parents about these issues as well as their preferred treatment options in Ethiopia. This study is, therefore, aimed at assessing the perception of parents about psychiatric illness in children and adolescents and their preferred treatment options in Jimma, Ethiopia. A cross-sectional study was conducted among 532 parents in Jimma City, Ethiopia from April to May 2013. Parents from the city were invited to participate in this study to assess their knowledge on causes, and manifestations of psychiatric illness in children and adolescents as well as their preferred treatment options if their children exhibited signs and symptoms of mental illness. Nearly three quarters of the parents identified genetic factors while approximately 20 % of them mentioned neuro-chemical disturbance as possible causes of their children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental health problems. On the other hand, magic, curse, and sin were mentioned as causes of mental health problems by 93.2, 81.8 and 73.9 % of the parents, respectively. Externalizing behavioral symptoms like &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;stealing from home, school or elsewhere&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and internalizing symptoms like &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;being nervous in new situations and easily loses confidence&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; were perceived by 60.9 and 38.2 % of the parents, respectively. The majority (92.7 %) of parents agreed that they would seek treatment either from religious or spiritual healers if their children developed mental illness. The low level of awareness about internalizing symptoms, the widespread traditional explanatory models as well as preference for traditional treatment options might present significant challenges to utilization of child and adolescent mental health services in this population. Public health intervention programs targeting parental attitude regarding the causes and treatment for child and adolescent mental health problems need to be designed and evaluated for their effectiveness in low-income settings. Additionally, including religious and spiritual leaders in the process of educating members of their respective churches and mosques should also be explored.
Background: A randomized nutritional supplementation trial among adult HIV patients, commencing a... more Background: A randomized nutritional supplementation trial among adult HIV patients, commencing antiretroviral treatment (ART) is in progress in Jimma, Ethiopia. The objective is to assess the effect of a whey-containing nutritional supplement to HIV infected patients commencing ART on general and HIV-specific treatment outcomes. Methods: A total of 400 HIV-patients (>18 years) initiating ART are randomized to ready to use supplementary food (RUSF) with either whey or soya, during the first 3 months or identical intervention from 3 to 6 months. Complete blood cell count, CD4+ count, anthropometry and physical activity are measured at baseline. In addition, demographic, and clinical data are recorded through standardized questionnaires. The primary outcome is changes in lean body mass after three and six months, assessed using deuterium dilution. Results: Of 213 participants enrolled at baseline 66.7 % were females, the mean age was 32.3 years+ 8.9, and BMI 19.4 ± 2.4 kg/m2. The m...
Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-... more Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa. Across-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization's Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol ('alcohol use disorders'). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value<0.25 were included in the final multivariable model. The overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respective...
This cross-cultural study was designed to examine cultural differences in empathy levels of first... more This cross-cultural study was designed to examine cultural differences in empathy levels of first-year medical students. A total of 257 students from the academic year 2010/11, 131 at Jimma University, Ethiopia, and 126 at the Ludwig Maximilian University, Munich, Germany, completed the Balanced Emotional Empathy Scale (BEES), the Reading the Mind in the Eyes (RME-R) test, and a questionnaire on sociodemographic and cultural characteristics. Furthermore, we conducted a qualitative analysis of the students' personal views on the definition of empathy and possible influencing factors. Group comparisons and correlation analyses of empathy scores were performed for the entire cohort and for the Jimma and Munich students separately. We used a regression tree analysis to identify factors influencing the BEES. The male students in Jimma (39.1 ± 22.3) scored significantly higher in the BEES than those male students from Munich (27.2 ± 22.6; p = 0.0002). There was no significant differen...
To determine the effects of lipid based nutritional supplements with either whey or soy protein i... more To determine the effects of lipid based nutritional supplements with either whey or soy protein in patients with HIV during the first three months of antiretroviral treatment (ART) and to explore effects of timing by comparing supplementation at the start of ART and after three months delay. Randomised controlled trial. Three public ART facilities in Jimma, Oromia region, Ethiopia. Adults with HIV eligible for ART with body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16. Daily supplementation with 200 g (4600 kJ) of supplement containing whey or soy during either the first three or the subsequent three months of ART. Primary: lean body mass assessed with deuterium dilution, grip strength measured with dynamometers, and physical activity measured with accelerometer and heart rate monitors. Secondary: viral load and CD4 counts. Auxiliary: weight and CD3 and CD8 counts. Of 318 patients enrolled, 210 (66%) were women, mean age was 33 (SD 9), and mean BMI was 19.5 (SD 2.4). At three months, participants receiving the supplements containing whey or soy had increased their lean body mass by 0.85 kg (95% confidence interval 0.16 kg to 1.53 kg) and 0.97 kg (0.29 kg to 1.64 kg), respectively, more than controls. This was accompanied by an increased gain of grip strength of 0.68 kg (-0.11 kg to 1.46 kg) for the whey supplement group and 0.93 kg (0.16 kg to 1.70 kg) for the soy supplement group. There were no effects on physical activity. Total weight gain increased by 2.05 kg (1.12 kg to 2.99 kg) and 2.06 kg (1.14 kg to 2.97 kg) for the whey and soy groups, respectively. In addition, in the whey supplement group overall CD3 counts improved by 150 cells/µL (24 to 275 cells/µL), of which 112 cells/µL (15 to 209 cells/µL) were CD8 and 25 cells/µL (-2 to 53 cells/µL) were CD4. Effects of the soy containing supplement on immune recovery were not significant. The effects of the two supplements, however, were not significantly different in direct comparison. Exploratory analysis showed that relatively more lean body mass was gained by patients with undetectable viral load at three months. Patients receiving delayed supplementation had higher weight gain but lower gains in functional outcomes. Lipid based nutritional supplements improved gain of weight, lean body mass, and grip strength in patients with HIV starting ART. Supplements containing whey were associated with improved immune recovery. Trial registration Controlled-trials.com ISRCTN32453477.
High rates of psychotic disorder among special populations of homicide offenders, females, youth ... more High rates of psychotic disorder among special populations of homicide offenders, females, youth and the mentally disordered, have received much investigation. Personality disorder, especially antisocial personality disorder, augments the relative risk ratio of violence, especially in combination with substance use disorder. Few studies of these correlates of violence and especially homicide have been reported in low- and medium-income countries (LMIC). Using the structured clinical interview for DSM diagnosis (SCID), personality disorders were identified in a cross sectional study involving 546 homicide offenders in Jimma prison, Ethiopia. Predictors of personality disorder were determined using multivariate analysis of various demographic and clinical variables, for example, age, psychiatric history and substance use. Out of the 316 offenders who completed the SCID, only 16% fulfilled DSM IV criteria for personality disorder. The rationale for killing, self-defence, anger and revenge (52% of offenders), planning involved in offending (50%) and reasonably high level of relationship functioning (57% married) were different from most data from the high-income countries. Diagnostically relevant cultural factors in LMIC, not in play in high-income countries, may explain the differences in personality disorders similar to other mental disorders and the underlying mediators of homicide.
Background: Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLH... more Background: Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa. Methods: Across-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization's Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol ('alcohol use disorders'). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value <0.25 were included in the final multivariable model. Results: The overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respectively. There was no significant difference in the prevalence of AUDs in persons receiving antiretroviral treatment compared to those who were antiretroviral therapy naïve (32.6% vs. 38.6%). AUDs were identified in 26.0% and 44.1% of females and males, respectively. Male gender, smoking cigarettes and psychological distress were positively associated independently with AUDs.
Child and Adolescent Psychiatry and Mental Health, 2015
Parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception and awareness about psychiatr... more Parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception and awareness about psychiatric illness in children and adolescents is an important determinant of early detection and treatment seeking for the condition. However, there has been limited information about the perception and awareness of parents about these issues as well as their preferred treatment options in Ethiopia. This study is, therefore, aimed at assessing the perception of parents about psychiatric illness in children and adolescents and their preferred treatment options in Jimma, Ethiopia. A cross-sectional study was conducted among 532 parents in Jimma City, Ethiopia from April to May 2013. Parents from the city were invited to participate in this study to assess their knowledge on causes, and manifestations of psychiatric illness in children and adolescents as well as their preferred treatment options if their children exhibited signs and symptoms of mental illness. Nearly three quarters of the parents identified genetic factors while approximately 20 % of them mentioned neuro-chemical disturbance as possible causes of their children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental health problems. On the other hand, magic, curse, and sin were mentioned as causes of mental health problems by 93.2, 81.8 and 73.9 % of the parents, respectively. Externalizing behavioral symptoms like &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;stealing from home, school or elsewhere&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and internalizing symptoms like &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;being nervous in new situations and easily loses confidence&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; were perceived by 60.9 and 38.2 % of the parents, respectively. The majority (92.7 %) of parents agreed that they would seek treatment either from religious or spiritual healers if their children developed mental illness. The low level of awareness about internalizing symptoms, the widespread traditional explanatory models as well as preference for traditional treatment options might present significant challenges to utilization of child and adolescent mental health services in this population. Public health intervention programs targeting parental attitude regarding the causes and treatment for child and adolescent mental health problems need to be designed and evaluated for their effectiveness in low-income settings. Additionally, including religious and spiritual leaders in the process of educating members of their respective churches and mosques should also be explored.
Background: A randomized nutritional supplementation trial among adult HIV patients, commencing a... more Background: A randomized nutritional supplementation trial among adult HIV patients, commencing antiretroviral treatment (ART) is in progress in Jimma, Ethiopia. The objective is to assess the effect of a whey-containing nutritional supplement to HIV infected patients commencing ART on general and HIV-specific treatment outcomes. Methods: A total of 400 HIV-patients (>18 years) initiating ART are randomized to ready to use supplementary food (RUSF) with either whey or soya, during the first 3 months or identical intervention from 3 to 6 months. Complete blood cell count, CD4+ count, anthropometry and physical activity are measured at baseline. In addition, demographic, and clinical data are recorded through standardized questionnaires. The primary outcome is changes in lean body mass after three and six months, assessed using deuterium dilution. Results: Of 213 participants enrolled at baseline 66.7 % were females, the mean age was 32.3 years+ 8.9, and BMI 19.4 ± 2.4 kg/m2. The m...
Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-... more Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa. Across-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization's Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol ('alcohol use disorders'). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value<0.25 were included in the final multivariable model. The overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respective...
This cross-cultural study was designed to examine cultural differences in empathy levels of first... more This cross-cultural study was designed to examine cultural differences in empathy levels of first-year medical students. A total of 257 students from the academic year 2010/11, 131 at Jimma University, Ethiopia, and 126 at the Ludwig Maximilian University, Munich, Germany, completed the Balanced Emotional Empathy Scale (BEES), the Reading the Mind in the Eyes (RME-R) test, and a questionnaire on sociodemographic and cultural characteristics. Furthermore, we conducted a qualitative analysis of the students' personal views on the definition of empathy and possible influencing factors. Group comparisons and correlation analyses of empathy scores were performed for the entire cohort and for the Jimma and Munich students separately. We used a regression tree analysis to identify factors influencing the BEES. The male students in Jimma (39.1 ± 22.3) scored significantly higher in the BEES than those male students from Munich (27.2 ± 22.6; p = 0.0002). There was no significant differen...
To determine the effects of lipid based nutritional supplements with either whey or soy protein i... more To determine the effects of lipid based nutritional supplements with either whey or soy protein in patients with HIV during the first three months of antiretroviral treatment (ART) and to explore effects of timing by comparing supplementation at the start of ART and after three months delay. Randomised controlled trial. Three public ART facilities in Jimma, Oromia region, Ethiopia. Adults with HIV eligible for ART with body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16. Daily supplementation with 200 g (4600 kJ) of supplement containing whey or soy during either the first three or the subsequent three months of ART. Primary: lean body mass assessed with deuterium dilution, grip strength measured with dynamometers, and physical activity measured with accelerometer and heart rate monitors. Secondary: viral load and CD4 counts. Auxiliary: weight and CD3 and CD8 counts. Of 318 patients enrolled, 210 (66%) were women, mean age was 33 (SD 9), and mean BMI was 19.5 (SD 2.4). At three months, participants receiving the supplements containing whey or soy had increased their lean body mass by 0.85 kg (95% confidence interval 0.16 kg to 1.53 kg) and 0.97 kg (0.29 kg to 1.64 kg), respectively, more than controls. This was accompanied by an increased gain of grip strength of 0.68 kg (-0.11 kg to 1.46 kg) for the whey supplement group and 0.93 kg (0.16 kg to 1.70 kg) for the soy supplement group. There were no effects on physical activity. Total weight gain increased by 2.05 kg (1.12 kg to 2.99 kg) and 2.06 kg (1.14 kg to 2.97 kg) for the whey and soy groups, respectively. In addition, in the whey supplement group overall CD3 counts improved by 150 cells/µL (24 to 275 cells/µL), of which 112 cells/µL (15 to 209 cells/µL) were CD8 and 25 cells/µL (-2 to 53 cells/µL) were CD4. Effects of the soy containing supplement on immune recovery were not significant. The effects of the two supplements, however, were not significantly different in direct comparison. Exploratory analysis showed that relatively more lean body mass was gained by patients with undetectable viral load at three months. Patients receiving delayed supplementation had higher weight gain but lower gains in functional outcomes. Lipid based nutritional supplements improved gain of weight, lean body mass, and grip strength in patients with HIV starting ART. Supplements containing whey were associated with improved immune recovery. Trial registration Controlled-trials.com ISRCTN32453477.
High rates of psychotic disorder among special populations of homicide offenders, females, youth ... more High rates of psychotic disorder among special populations of homicide offenders, females, youth and the mentally disordered, have received much investigation. Personality disorder, especially antisocial personality disorder, augments the relative risk ratio of violence, especially in combination with substance use disorder. Few studies of these correlates of violence and especially homicide have been reported in low- and medium-income countries (LMIC). Using the structured clinical interview for DSM diagnosis (SCID), personality disorders were identified in a cross sectional study involving 546 homicide offenders in Jimma prison, Ethiopia. Predictors of personality disorder were determined using multivariate analysis of various demographic and clinical variables, for example, age, psychiatric history and substance use. Out of the 316 offenders who completed the SCID, only 16% fulfilled DSM IV criteria for personality disorder. The rationale for killing, self-defence, anger and revenge (52% of offenders), planning involved in offending (50%) and reasonably high level of relationship functioning (57% married) were different from most data from the high-income countries. Diagnostically relevant cultural factors in LMIC, not in play in high-income countries, may explain the differences in personality disorders similar to other mental disorders and the underlying mediators of homicide.
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