Ethiopian Journal of Health Sciences

Editorial: The rationale for Health and Demographic Surveillance System (HDSS) in urban populations in Ethiopia

Yemane Berhane — 2024-12-27

Editorial

The Addis Health and Demographic Surveillance System (Addis-HDSS): Context and Method

Semira Abdelmenan — 2024-12-27

BACKGROUND: Accurate population-based data is essential for evidence-based public health decision-making. Monitoring health events and evaluating interventions through a population-based platform enables timely decisions in rapidly growing urban areas. Such platforms are rare in African countries. This paper outlines the procedures for establishing the Addis Health and Demographic Surveillance System (Addis-HDSS).

METHODS: The Addis-HDSS, located in Yeka sub-city of Addis Ababa, Ethiopia, conducted its first census from December 3, 2022, to January 18, 2023. Each enumeration area was identified and mapped digitally. All households in the study area were visited and geocoded. The baseline census gathered data on sociodemographic status, housing conditions, economic status, and selected health-related factors.

RESULTS: A total of 30,533 households and a population of 107,494 were recorded. The response rate was 99.1%, reflecting high community engagement. The average household size was 3.5, and the sex ratio was 81 males to 100 females. The population structure resembled a typical low-income country profile.

CONCLUSION: Establishing an urban HDSS was feasible with reasonable effort due to the presence of a digital map and the willingness of the urban population. This surveillance system will be an asset to generate reliable urban health and demographic information by providing an unbiased sampling frame for health-related studies. The HDSS will also be used to test the effectiveness of population-based public health interventions.

Household Sanitation and Crowding Status in Addis Health and Demographic Surveillance System (Addis-HDSS) in Addis Ababa, Ethiopia

Walelegn W. Yallew — 2024-12-27

BACKGROUND: Access to sanitation and healthy housing conditions are essential for public health, reducing the spread of diseases and improving overall well-being. However, millions of people, particularly in low-income countries, still lack access to basic sanitation and housing facilities. This study assessed household sanitation and crowding status in a rapidly developing urban area of Addis Ababa.

METHODS: Data were extracted from the household census conducted from December 2022 to January 2023 at the Addis-HDSS site. Availability of basic sanitation facilities was defined as the presence of privately owned sanitation facilities within the household. Household crowding was measured by the number of occupants per bedroom. Multivariable logistic regression was used to identify factors associated with access to sanitation facilities (STATA/SE 14.2). A p-value of <0.05 was considered statistically significant.

RESULTS: The study included 30,533 households. Overall, 76.37% (95% CI: 74.86–77.2) lacked access to basic sanitation facilities. Most households (67.42%) lived in overcrowded housing. Educational status of the household head and household size were significantly associated with sanitation access. Households with college-educated heads were more likely to have access to basic sanitation (AOR 2.52, 95% CI: 2.27–2.79), while overcrowded households were less likely to have such access (AOR 0.06, 95% CI: 0.040–0.063).

CONCLUSIONS: A large proportion of households lacked basic sanitation facilities and lived in overcrowded housing, which increases the risk of infectious disease transmission. Improving sanitation and housing conditions is crucial for reducing health risks and improving public health outcomes.

Agreement Between a Subjective Single-Item Socioeconomic Status and Wealth Index in the Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia

Hanna Gulema — 2024-12-27

BACKGROUND: Measuring household economic status is crucial, as it is a key determinant of health. In low-income settings, no single measure of economic status is universally accepted. This study aims to assess the agreement between a single-item tool for measuring socioeconomic status (SES) and the wealth index.

METHODS: The Addis Health and Demographic Surveillance System (Addis-HDSS), based in Addis Ababa, Ethiopia, collects data on various socioeconomic indicators, including income, expenditure, and asset ownership. In this study, a single question, "Does your family's income cover basic needs?" was used as a proxy for SES. The percent agreement with the wealth index was calculated, and significance was assessed using the Pearson chi-square test. Scale reliability was evaluated using Cronbach’s alpha (α).

RESULTS: Data from 30,533 households showed strong agreement (α = 0.925) between self-reported income adequacy and wealth for both lower and higher wealth groups. The highest agreement was found between the lowest wealth index and "very low" income adequacy (93.84%) and between the highest wealth index and "high" income adequacy (89.47%) (p < 0.001).

CONCLUSION: The single-item SES measure showed good agreement with the wealth index in an urban setting. This simple tool can effectively identify vulnerable populations for targeted health interventions. Further research is needed to assess its applicability in other contexts.

Healthcare Facility Preference among Households in Addis Health and Demographic Surveillance Site (ADDIS-HDSS), Addis Ababa, Ethiopia

Yoseph Yemane Berhane — 2024-12-27

BACKGROUND: Understanding healthcare facility preferences—public versus private—is essential for formulating policies that promote universal health coverage (UHC). Various sociodemographic factors influence these preferences. This study examines healthcare facility preferences within the ADDIS-HDSS population in Addis Ababa, Ethiopia.

Methods: This analysis is based on the ADDIS-HDSS baseline census conducted in Yeka sub-city, Addis Ababa. We focused on respondents' preferred healthcare facility when household members are ill, and the reasons behind their choice. Multivariable logistic regression was used to analyze the factors influencing preferences.

Results: Most households (82.81%) preferred public healthcare facilities, citing affordability as the primary reason (59.31%). The remaining 17.19% preferred private healthcare, mainly due to perceived quality of care (43.06%) and timeliness (37.04%). Larger family size was associated with a reduced likelihood of preferring private facilities (AOR = 0.579, 95% CI: 0.522–0.642), while higher education (AOR = 2.573, 95% CI: 2.194–3.017) and wealthier households (AOR = 16.925, 95% CI: 14.705–19.481) were more likely to prefer private care.

Conclusion: The majority of households prefer public healthcare facilities, with affordability, quality, and timeliness as key factors. To achieve UHC in low-income countries, improving service quality and timeliness in public healthcare is critical.

Self-rated Health Status of the Adult Population in Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia

Dagmawit Tewahido — 2024-12-27

BACKGROUND: Self-rated health (SRH) status is a subjective assessment of one's health condition and can serve as a reliable indicator of a community’s overall health. This study aimed to evaluate the SRH status of communities and its association with socio-demographic and health-related variables at the population level.

METHODS: Data were obtained from the Addis Health and Demographic Surveillance System. SRH was assessed through a single question: "In general, would you say that your health is excellent, very good, good, fair, or poor?" These five categories were transformed into two groups: “Good SRH” and “Poor SRH.” Bivariate and multivariate logistic regression analyses examined associations between SRH status and socio-demographic and health-related characteristics.

RESULTS: A total of 46,483 adults (aged 18 and above) were included in the study. Of these, 4,377 (9.42%) participants reported poor SRH status. Male sex (OR 0.87; 95% CI: 0.80 – 0.94), higher educational level (OR 1.90; 95% CI: 1.67 – 2.17), and the highest wealth index (OR 1.76; 95% CI: 1.55 – 2.00) were significantly associated with good SRH status, while older age (OR 0.15; 95% CI: 0.12 – 0.18) and the presence of any chronic illness (OR 0.08; 95% CI: 0.07 – 0.09) were directly and significantly associated with poor SRH status.

CONCLUSION: Poor SRH status was more prevalent among females, older individuals, those with lower education, lower wealth index, and those with chronic illnesses. These findings highlight the need for robust health facilities and support systems for women and the elderly population.

Population Nutritional Status in Addis Health and Demographic Surveillance System (ADDIS-HDSS), Addis Ababa, Ethiopia

Tigest Shifraw — 2024-12-27

BACKGROUND: Low—and middle-income countries face a double burden of malnutrition. However, comprehensive, population-based nutritional assessments are rare, particularly across all age groups. This study aimed to assess the prevalence of malnutrition across different age groups in Addis Ababa Health and Demographic Surveillance Site (Addis-HDSS), Addis Ababa, Ethiopia.

METHODS: A community-based cross-sectional survey was conducted from December 2022 to January 2023 in Addis Ababa, involving residents of the Addis-HDSS sites. Mid-upper arm circumference (MUAC) was used to assess nutritional status for individuals aged 6 months to 64 years. Descriptive statistics were analyzed using STATA version 14, employing previously published age-specific cutoff points to define underweight, overweight, and obesity.

RESULTS: A total of 37,364 individuals aged 6 months to 64 years participated. Among children aged 6-59 months, 4.2% had moderate acute malnutrition (95% CI: 3.7-4.9), and 3.0% had severe acute malnutrition (95% CI: 2.5-3.6). Overweight prevalence was 22.3% (95% CI: 20.3-24.3) in children aged 5-9 years, 25.9% (95% CI: 23.4-28.5) in adolescents aged 10-14 years, and 12.7% (95% CI: 11.5-14.0) in late adolescents aged 15-19 years. Among adults aged 20-64 years, 6.3% were underweight (95% CI: 6.0-6.6), 19.3% overweight (95% CI: 18.8-19.7%), and 21.5% obese (95% CI: 21.0-22.0).

CONCLUSIONS: This study highlights a double burden of malnutrition in Addis Ababa, with overweight and obesity more prevalent than underweight, especially in adolescents and adults. It underscores the need for interventions targeting both undernutrition and overnutrition, emphasizing better diets and physical activity to curb nutrition-related diseases.

Socio-Economic Determinants of Contraceptive Use among Married Women in the Addis Urban Health and Demographic Surveillance System (Addis-HDSS) in Ethiopia

Hanna Yemane Berhane — 2024-12-27

BACKGROUND: Contraceptives are essential for protecting women’s sexual and reproductive health, as well as for reducing maternal and infant morbidity and mortality. This study aimed to identify socioeconomic factors associated with contraceptive use among married women of childbearing age in Ethiopia.

METHODS: We analysed cross-sectional data from 15,499 married women aged 18-49 years, collected as part of the Urban Health and Demographic Surveillance System (HDSS) in Addis Ababa. Trained interviewers conducted face-to-face interviews using structured, pre-tested questionnaires. Bivariable and multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CIs) to assess associations between socioeconomic factors and contraceptive use.

RESULTS: The overall prevalence of contraceptive use among married women was 53.5% (95% CI: 52.7-54.4%). Women with larger family sizes (>6) (AOR: 2.1; 95% CI: 1.5-2.8), excellent self-reported health (AOR: 1.6; 95% CI: 1.3-1.9), and those in households with adequate income to meet basic needs (AOR: 1.29; 95% CI: 1.11-1.48) were more likely to use contraceptives. Women over 40 years old (AOR: 0.21; 95% CI: 0.18-0.25) and those living in female-headed households (AOR: 0.68; 95% CI: 0.61-0.76) had lower odds of using contraception.

CONCLUSION: About half of urban married women of reproductive age reported using contraceptives. Factors associated with higher contraceptive use included better self-reported health and larger family sizes. Further research is needed to understand the complex dynamics of contraceptive use in low-income urban settings.

Prevalence of Self-Reported Chronic Non-Communicable Diseases among Adults in Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia

Semira Abdelmenan — 2024-12-27

BACKGROUND: Chronic non-communicable diseases (NCDs) are a global health challenge, causing millions of deaths annually and contributing significantly to the global disease burden. Despite their prevalence in low- and middle-income countries (LMICs), NCDs receive limited global health financing. Ethiopia, like other LMICs, is experiencing a rising burden of NCDs. This study aimed to assess the self-reported prevalence of chronic NCDs and identify associated sociodemographic factors.

METHODS: A population-based cross-sectional study was conducted at the Addis Health Demographic Surveillance System (Addis-HDSS) site in Addis Ababa, Ethiopia. All adults (≥18 years) living in the Addis-HDSS sites were included. Data were collected using a structured electronic questionnaire on self-reported NCDs and sociodemographic variables. Binomial regression model was used to identify sociodemographic factors associated with self-reported NCDs.

RESULTS: Overall, 11.5% (95% CI: 11.3%-11.7%) of adults reported at least one NCD. The most prevalent conditions were hypertension (5.9%; 95% CI: 5.7%-6.1%) and diabetes mellitus (3.4%; 95% CI: 3.3%-3.5%). Older age (Adjusted Incidence Rate Ratio (AIRR): 5.47; 95% CI: 5.17-5.79), no formal education (AIRR: 1.58; 95% CI: 1.45-1.72), being formerly married (AIRR: 2.68; 95% CI: 2.47-2.91), and higher wealth quintiles (AOR: 1.16; 95% CI: 1.07-1.26) were statistically significant risk factors associated with NCDs.

CONCLUSION: This study highlights the high burden of chronic NCDs among adults in Addis Ababa. The findings highlight the importance of addressing NCDs as a significant public health challenge. Expanding access to early prevention, diagnosis, and care is critical in urban settings.

Prevalence of Reported Mental Illness in Addis Ababa, Ethiopia: A Community-Based Study

Sitota Tsegaye — 2024-12-27

BACKGROUND: Mental illness is the second leading cause of disease burden globally, following cardiovascular diseases. Over 25% of people worldwide will experience mental illness at some point, and low-income countries contribute 12% of the global disease burden. However, data on mental disorders are scarce in low-income countries, leading to insufficient attention to mental illness prevention and treatment. This study assesses the prevalence of mental illness and its associated factors in Addis Ababa.

METHODS: This study was conducted in the Addis Health and Demography Surveillance System (Addis HDSS) in Yeka sub-city, Addis Ababa, using a structured questionnaire. The prevalence of reported mental illness was calculated with 95% confidence intervals (CIs), and logistic regression was employed to examine factors such as age, sex, chronic illness, physical disability, and wealth index associated with mental illness.

RESULTS: A total of 107,494 respondents participated, with 44.6% men. The average age was 29.23 ± 18.97 years. The reported prevalence of mental illness was 1.1% (95% CI: 1.1–1.2), with 50.7% of those affected being men. Mental illness was more common in individuals aged 65 years and older. The odds of reported mental illness were higher in men (AOR 1.24; 95% CI 1.12–1.39), in those with physical disabilities (AOR 10.12; 95% CI 8.64–11.84), and in those with chronic illness (AOR 2.35; 95% CI 1.22–4.54).

CONCLUSION: This study adds to the limited data on mental illness prevalence in the community, highlighting it as a significant health burden. The results emphasize the need for healthcare planning focused on mental health and increased community awareness. Particular attention should be given to vulnerable groups, including the elderly, those with physical disabilities, and those with chronic illnesses.