SUMMARYA community-based seroepidemiological survey of Addis Ababa, Ethiopia was conducted in 1994 to inform on the transmission dynamics and control of hepatitis B virus (HBV) infection. Venous blood from 4736 individuals under 50 years of age from 1262 households, selected using stratified cluster-sampling, was screened for HBV markers using commercial ELISAs. HBsAg prevalence was 7% (95 % CI 6-8), higher in males (9 % ; 7-10) than females (5 %; 4-6). HBeAg prevalence in HBsAg positives was 23 % (18-29), and less than 1 % of women of childbearing age were HBeAg positive. Overall HBV seroprevalence (any marker), rose steadily with age to over 70 % in 40-49 year olds, indicating significant childhood and adult transmission. Estimated instantaneous incidence was 3-4/100 susceptibles/year, higher in males than females in 0-4 year olds, and peaking in early childhood and young adults. The age at which 50 % had evidence of infection was around 20 years, and the herd immunity threshold is approximated at 63-77%. Addis Ababa is of intermediate-high HBV endemicity, with negligible perinatal transmission. Our main findings are the identification of a significant difference between males and females in the age-acquisition of HBV infection, and marked differences between age groups in HBV incidence rates. These results should target future research studies of underlying risk factors. Furthermore, we generate a crude estimate of the level of coverage of HBV vaccine that would be required to eliminate the virus from the study population.

Serum samples (n = 4,593) collected in 1994 as part of a representative household community survey of the population of Addis Ababa who were 0-49 years old were tested for hepatitis C (HCV) antibodies. A third generation ELISA was used for primary screening and a line immunoblot assay for confirmation. HCV antibody prevalence was 0.9% (95% CI, 0.6-1.2%) and higher among HIV-positive compared to HIV-negative individuals (4.5% vs. 0.8%, respectively, P < 0.001). Similar higher prevalence of HCV antibodies was seen among HIV-positive compared to HIV-negative antenatal care attenders (2.9% vs. 0.8%, respectively, P = 0.003, n = 1,725), and sex workers (5.3% vs. 1.3%, respectively, P = 0.02, n = 383). Such association between HCV and HIV infection has not been described previously in Africa. After stratification by HIV status, HCV prevalence among women of the general population was identical to that of sex workers, suggesting that HCV sexual transmission is not common in this population and that HIV infection does not enhance susceptibility to HCV sexual transmission.

Objective: To gain a better understanding of the attitude and social consequences of tuberculosis (TB) in Addis Ababa, Ethiopia. Design: A cross sectional survey using a structured questionnaire and a qualitative study based on the focus group discussion (FGD) technique. Setting: Eight different kebeles (urban dwellers' associations) of six woredas (next higher administrative level to kebele). Subjects and methods: Seven hundred and three participants, comprising 326 males and 377 females were interviewed using the written questionnaire and 36 recent and current TB patients through focus group discussion. Data were analysed using SPSSRC statistical package. The proportions were compared using univariate and bivariate analyses to show the frequency distribution and evaluate the relationship among different variables. In FGD, topics relevant to the research questions were identified, sorted and analysed. Conclusions were then formulated. Main outcome measures: Attitude of participants towards TB and its victims and social consequences of being a TB patient. Results: Eighty three per cent of the respondents were aware that TB is a disease transmitted from one person to another and 80.1 % perceived TB as an extremely severe disease. Of the total, 81.5% answered that TB is caused by cold, 69.0% feel that TB patients are not accepted in the community and 78.3% fear physical contact with TB patients. Most participants of the FGD sessions agreed that TB is a very dangerous, contagious but curable disease and the community has a generally negative attitude towards them. They also think that TB is associated with EIIVIAIDS in thesociety. These attitudes have social consequences particularly the stigmatisation and social isolation of TB patients. Four hundred and four (57.5%) respondents were found to be in favour of the short course chemotherapy against 226 (32.1 %) choosing the longer course. Clinical improvement and unavailability of some drugs o r their cost were the first and second main reasons indicated, respectively, for defaulting by respondents. Conclusion: The perception by most respondents that tuberculosis is incurable, transmittable and associated with HIVIAIDS, led to the understanding that TB is a very dangerous disease. This, in turn, contributes to social avoidance and the resultant consequences in TB patients. Health education must bestepped-up within the TB control programme,and the psychosocial implications of TB should be given due attention.

SUMMARYWe conducted a community-based cluster sample survey of rubella sero-epidemiology in Addis Ababa, Ethiopia in 1994. Among 4666 individuals for whom complete data were available, rubella antibody prevalence was 91 % (95 % confidence interval : 90, 92). On multivariable analysis, seroprevalence was lower among individuals who were resident in Addis Ababa for 1 year or less. Approx. 50 % seroprevalence was attained by age 4 years, and the estimated average age at infection was 5n2 years. The highest age-specific force of infection was estimated to occur in 5-to 9-year-olds. The early age at infection corresponded with a low estimated incidence of congenital rubella syndrome (CRS) of 0n3 per 1000 live births, equivalent to nine cases of CRS in 1994. The predicted critical level of immunity for elimination of rubella via vaccination was 85-91 %, requiring 89-96 % coverage with a vaccine of 95 % effectiveness. Unless very high coverage of rubella vaccine could be guaranteed, the introduction of childhood vaccination could increase the incidence of CRS in Addis Ababa.

Background: The use/abuse of psychoactive drugs such as khat leaves (Catha edulis) are believed to alter one's moods or emotional state either through the sustained release or inhibition of neurotransmitters, thereby enhancing or dampening the response of the individual. Most people whose thinking are warped by continued drug use may not be able to see the harm resulting from their actions. Thus, there has been a strong linkage between drug use and casual or unsafe sexual practice despite the serious concern about HIV infection. Objective: Khat chewing is known to be a widespread habit in Ethiopia. This study is, thus, aimed at investigating whether or not the use of this psychostimulant alone or in conjunction with other behaviors associated with its use constitutes a risk behavior that accelerates the spread of HIV infection. Methods: A case-control study involving 850 human subjects, i.e. 425 HIV positives (cases) and 425 HIV negatives (controls) was conducted using rapid test algorithm and/or western blot method for determination of HIV status. Both groups were interviewed about their probable khat chewing habits, alcohol intake, multiple sexual practice, and the like, using a structured questionnaire. The data were analysed using SPSS/PC + statistical software. Results: Risk behaviors for HIV infection such as khat chewing in conjunction with alcohol intake and casual sex were observed more in people with HIV than in the control group. Khat chewing was significantly associated with multiple sexual practice (OR = 4.03, 95% CI = 3.02, 5.39), which in turn was strongly linked with HIV cases (OR = 3.52, 95% CI = 2.64, 4.69). Thus, more than the non-chewers, khat chewers constituted significantly higher number of HIV cases (OR =2.32, 95% CI = 1.75, 3.07). Conclusion/Recommendations: Khat chewing is a risk behavior for the spread of HIV infection. Mainstreaming of khat control into national development planning initiatives is recommended.