Non-Communicable Diseases (NCD) Project: Increasing Access to Services through Training and Capacity Building across Ethiopia
Funder: Novartis Social Business
NCDs are a particular concern in Ethiopia’s rural areas. Rural patients, many of them very poor, face long journeys to hospitals and health centres in difficult conditions and at high cost. They need access to NCD services closer to their homes. In response to a request from the Federal Ministry of Health (FMoH), the Tropical Health and Education Trust (THET), Health Poverty Action (HPA) and Novartis Social Business have joined forces to train hospital and health centre staff, ensuring that patients no longer need to travel long distances for treatment. The project will also train 2,250 health extension workers so they can bring NCD prevention and management education directly to local communities.
The Ministry has selected 60 sites for its next phase of decentralisation for hypertension, diabetes, epilepsy and chronic respiratory disease. Hospital and health centre staff will be trained to diagnose and treat NCD patients, ensuring that community members no longer need to travel far for their regular treatment.
Read our latest project report here.
Funder: Veta Bailey
Stroke is the second leading cause of premature mortality globally and in Ethiopia is becoming an increasingly prevalent cause of hospital admissions. Therefore, THENA is pleased to announce that we have received the Brian Worth Award from the Veta Bailey Trust to support improving stroke care in Ethiopia.
THENA established the first organised stroke care programme in Ethiopia in 2016, in collaboration with Jimma and Gondar University Hospitals. With support from the stroke team from University Hospital Southampton, we trained a senior nurse at each site to lead on the implementation of stroke care protocols. Since then we have trained 50 nurses and physiotherapists in stroke care across the two sites.
During the first two years of the new programme, made possible by this award, two senior nurses will be trained as trainers in stroke care at Jimma and Gondar. Formal accreditation as trainers will be obtained from their universities, enabling them to deliver training to other nurses as required. They will also be responsible for data collection and assessment of impact, with support from the Southampton team.
Patient Communication: The NCD Story Book
Many NCDs occurring in Ethiopia are relatively new to the country and as a consequence are often poorly understood by the patient population. A particular misunderstanding is the need for long-term drug treatment and management of conditions such as diabetes or high blood pressure. Many patients will come to the clinic expecting a cure – the Amharic word used for medicine is the same word as is used for a cure or a healing- and will go away disappointed. There is a need for a better and culturally appropriate means of communicating about NCDs to potential patients. We have therefore commissioned a well-known Ethiopian author, film maker and artist to produce a story book with an embedded message about the necessity of NCD treatment. We are planning to investigate its usefulness in the Gondar area and if successful will commission further books/linked films.
Insulin-dependent Diabetes in Gondar
Type 1 diabetes (diabetes which needs to be treated with insulin injections) is a difficult disease to manage in sub-Saharan Africa and conditions are often poorly controlled, making patients prone to complications and to early mortality. This type of diabetes is the most common form of the disease occurring in the rural areas around the city of Gondar. However, the disease in Ethiopia is unusual in that, unlike the disease in the UK, it presents at a much older age, and is strongly associated with poverty. The THENA have had a research interest for several years and have various ongoing projects to investigate its epidemiology and immunopathogenesis and to improve the outcome for patients.
Rheumatic Heart Disease in Jimma
Rheumatic heart disease is a disease that is closely linked to poverty which is common in sub-Saharan Africa. In rural areas it is often the major cause of heart disease far surpassing that of coronary heart disease. It is greatly neglected and still poorly understood and yet it is a significant cause of heart failure and death in young adults. Together with Professor Magdi Yacoub and supported by the charity, Chain of Hope, we have been investigating the prevalence and social determinants of rheumatic heart disease in the rural area around Jimma.
Air Pollution – Collaboration with Addis Ababa University
In Ethiopia, like many countries in Africa, the most common form of air pollution is from the use of open fires in people’s homes. Exposure to smoke from these fires has significant health consequences and the problem is now a key public health focus. In collaboration with Professor Mirgissa Kaba of Addis Ababa University’s Department of Public Health, our research has found that there are important and prevalent cultural beliefs in Ethiopia that smoke has purifying and healing properties. Filling a room with smoke may be used, for example, in treating a sick child and this is especially prevelant if Western Medicine is not available. We have an ongoing project to investigate these beliefs and how they interact with the current public health focus on the necessity to reduce domestic air pollution.
Loss to Follow-up in NCD Clinics – Jimma
One of the big problems we have faced in Ethiopia is poor patient engagement with the NCD clinic – a large proportion of patients will cease attending the clinic after one or two appointments. As little is known about the reasons for this, we initiated a project in the clinics around Jimma to see if we could locate patients who had stopped attending the clinic and to find out what had happened to them. Although this was a challenging undertaking, we found that while some patients had attended other clinics, many had failed to understand the need for long-term treatment of their illness or had sought treatment from traditional healers.