The Impact of Ethiopian Health Services Extension Program on Maternal and Child Health Outcomes:The Case of Tigray Region

Abstract Background: The Health Extension Program (HEP) is one of the most innovative community-based health programs launched by the Ethiopian Federal Ministry of Health (FMOH) to make health services accessible to rural communities by setting out women health extension workers (HEWs) in rural health posts. The program was officially rolled out in 2003 and become operational in 2004. Its approach is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Deployed as pairs, the HEWs are premised to provide basic, largely preventive, primary health services to rural villages and empower families to take charge of their own health. Primarily, the program gives special attention to children and mothers. Objectives: The primary objective of this study was to evaluate the short and medium-term impact of the HEP on maternal and child health outcomes in Tigray region and analyze if the impact suggests that the region is moving in a direction towards achieving the 4th and 5th Millennium Development Goals (MDGs). Additionally, the study sought to provide some policy relevant insights into the performance of the program in the region. Methods: Using administrative data, the study estimated the impact of the HEP on child health variables (ex., child vaccines:-DPT3, BCG, OPV3 & measles and full immunization) and on maternal health (ex., tetanus toxoid injection and attended delivery). Two empirical models were estimated. Using these models, the study estimated multiple regression equations for each outcome of interest against the predictor variable (HEW coverage) controlling for confounding factors such as electricity, telephone etc. and year to capture variations over time. Results: Since it became operational in 2004, the program has had a tangible effect on child health outcomes. Results showed that a 10% increase in the program (HEWs coverage) increased full immunization rates by 1.85%, BCG vaccination by 2.6%, DPT3 by 2.4% and OPV3 by 2.7%, all of which were statistically significant. However, the impact on measles was found statistically insignificant. For maternal health outcomes, results showed that a 10% increase in the program coverage increased TT2 uptake of pregnant women by only 0.5%, TT2 by non-pregnant women 0.08%, and attended delivery by 1.06%--all statistically insignificant. Conclusion: Result of the estimation indicated that there is significant impact on child health indicators which could be attributable to the presence of the HEP in the districts. Particularly, the program has statistically significant effect on BCG, OPV3, DPT3 and full immunizations. Although the impact on measles was positive, it was not statistically significant. No effect of the program on maternal health indicators was found .Therefore, federal, regional and local governments should put collaborative efforts to increase the utilization of maternal health services as well as support and strengthen the outreach effort of the health extension workers to reach the targeted goal

Voltammetric determination of tinidazole in pharmaceutical tablets using carbon paste electrode

Cyclic voltammetry was used to study the electrochemical behavior of tinidazole at carbon paste electrode. Tinidazole showed an irreversible reduction peak at about -440 mV. The differential pulse voltammetric peak current of tinidazole showed linear dependence on concentration in the range 5.0-200 μM with LOD and LOQ of 5.1 10-7 and 1.7 10-6 μM, respectively. Relative to most of the reported works on the determination of tinidazole, the developed method using carbon paste electrode which is an environmentally friendly, cheap, and simple working electrode exhibited linear dependence of peak current on concentration in the lower concentration region with relatively low LOD. Excellent recovery results with low % RSD for spiked standard tinidazole in tablet samples showed the potential applicability of the developed method for the determination of tinidazole in real samples. KEY WORDS: Carbon paste electrode, Differential pulse voltammetry, Tinidazole, Pharmaceutical tablets Bull. Chem. Soc. Ethiop. 2016, 30(1), 1-12.DOI: http://dx.doi.org/10.4314/bcse.v30i1.

Antagonistic Effect of Native Bacillus Isolates against Black Root Rot of Faba Bean

Faba bean (Vicia faba L.) is one of the most important pulse crops grown in eastern Africa. Black root rot (Fusarium solani) is known to cause great yield losses in faba bean, especially in the highlands of Ethiopia. The objective of this study was to evaluate the biological control ability of native Bacillus species on the basis of their antagonistic effects against F. solani. The study was conducted in vitro and in a greenhouse. All tested Bacillus isolates significantly (P<0.05) reduced radial mycelial growth of the pathogen. Seven bacterial isolates restricted growth of the pathogen to <14 mm diameter, and showed 39-44% efficacy over the positive control. Isolate BP048 was the most effective, with 43.6% efficacy. The lowest inhibitory effects, 15.5 and 27.8%, were recorded from isolates BS083 and BS0102, respectively. The culture filtrate of the bacterial isolates also inhibited F. solani spore germination. In vivo, the isolates significantly reduced severity of black root rot on artificially inoculated faba bean seedlings. The antagonist Bacillus isolates kept black root rot severity low with more than 50% disease suppression, compared to the untreated control.Keywords: Ethiopia, Fusarium solani, Vicia faba

Diabetic foot disease in Ethiopian patients: A hospital based study

Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability, morbidity and mortality among diabetic patients and about 15% develop foot ulcers in their lifetime. So far, there are few published data in relation to the high-risk diabetic foot in Ethiopian subjects. Methods: A retrospective study was done to determine the various risks as well as antecedent factors, other long term complications, treatment profile and subsequent follow up of 196 patients with diabetic foot disease admitted to the Tikur Anbessa Specialized Referral Hospital from Jan 1999 to Dec 2003. Patients’ medical records were reviewed using pre-prepared formats and relevant data were abstracted. The data were analyzed using Epi info version 3.4.3 statistical soft ware. Results: A total of 196 patients were included in this study. The male to female ratio was 3 to 1. The median age was 60 years (IQR, 47-65). Median duration of symptoms before presentation was 21 days (IQR, 14-30) and the median duration of diabetes mellitus was144 months (IQR, 60-216). More than two thirds had type 2 diabetes mellitus. Among 109 patients with identified antecedent risk factors for their foot problem, ill fitting or new shoes attributed in 48(44%). Neuro-ischaemic ulcers were seen in 113 (58%) of the cases and neuropathic ulcer in 63 (32%). Ulcer with cellulitis or gangrene was the most common mode of presentation seen in 92 (47%) of the patients. Ninety two (47%) patients had amputations. Re-amputation was necessary in 24 (26%) of these cases. Less than 40% of the total cases had a regular follow up either at a clinic or hospital. Diabetes was diagnosed for the first time in 7 cases (4%) on presentation with foot ulcer. The mean glycemic level was poorly controlled in over 80% of the cases. The overall mortality rate was 21% and sepsis was the most identified cause. Conclusion: Lack of regular patient follow up and diabetes education on foot care, poor glycemic control, delay in patient presentation and surgical intervention as well as patients’ refusal to undergo surgical interventions were the reported contributing factors for the observed high mortality. Recommendation: Diabetic education on foot care, emphasis on metabolic control of diabetes, early presentation and surgical intervention when appropriate has to be highlighted in the management of diabetic patients. More studies have to be done in relation to the high-risk diabetic foot particularly in the Ethiopian setting emphasizing on preventive aspects

Evaluation of soil solarisation and bio-fumigation for the management of bacterial spot of tomato

Soil-borne plant pathogens cause heavy losses to all major crops, leading to reductions in both yield and quality. Soil solarisation and bio-fumigation offer disease management options that are safe and reduce the use of pesticides for soil-borne plant pathogens. Mustard plant releases antimicrobial hydrolysis products, notably isothiocyanates when used as a bio-fumigant. Bacterial spot of tomato caused by Xanthomonas campestris pv. vesicatoria (Xcv) can survive in soil and plant debris, which serve as a primary inoculum for infecting the next tomato crop. An experiment was carried out with the objective of evaluating effects of soil solarisation and the use of Ethiopian mustard (Brassica carinata A. Braun) as a bio-fumigant to control bacterial spot disease and on yield of tomato. The treatments consisted of six types of potted soil medium (solarised at Haramaya and Dire Dawa, bio-fumigated, biofumigated as well as solarised at Haramaya and Dire Dawa, and untreated control as non-solarised non-biofumigated pots). Treated tomato seeds were planted and fruit yields were compared among treatments. Potted soil was inoculated with the pathogen, Xcv, belonging to T2P2 race group. The total microbial and Xcv counts were done before as well as after setting up the experiment. The results revealed that solarisation reduced the population of Xcv from 10.68 to 8.79 CFU g-1, total bacterial population from 11.27 to 9.86 CFU g-1, and total actinomycete counts from 11.69 to 9.44 CFU g-1 while bio-fumigation had a non-significant effect on Xcv and total microbial counts. None of the treatments exhibited a significant effect on fungal counts. The fruit yield of tomato grown on biofumigated as well as solarised soil was the highest (91.18 t ha-1) as compared to the other treatments. It can, therefore, be concluded that solarisation and bio-fumigation cannot be used as a bio-rational option for effective management of Xcv on tomato but the two methods could be used to increase tomato yield in the presence of the pathogen.Key words: bio-fumigation, solarisation, bacterial leaf spo

Use of geographic information system and water quality index to assess suitability of groundwater quality for drinking purposes in Hewane areas, Tigray, Northern Ethiopia

The study area Hewane is situated in the southern zone of Tigray Regional State, Hintalo Wajirat wereda. It is geographically located between 1444000 to 1454000m N and 550000 to 558000m E with an aerial extent of 47.66 sq. km. The study was conducted having an objective of assessing suitability of groundwater quality for drinking purposes through geographic information system (GIS) and water quality index (WQI). Ten groundwater samples were collected from the study area and 13 physicochemical parameters such as TDS, TH, Alkalinity, pH, EC, Temperature, Na+, K+, Mg2+,Ca2+, Cl-, HCO3- and SO42- were analyzed. Inverse distance weighted (IDW) interpolation method has been used to generate the spatial distribution of the groundwater physico-chemical parameters and water quality index map. To estimate the water quality index, 9 parameters have been considered: pH, Na+, K+, Mg2+,Ca2+, Cl-, HCO3-, SO42-, and TDS. The WQI estimated for the groundwater samples of the study area ranges from 86.1 to 180.5 at groundwater samples GWS_2 and GWS_5, respectively. Based on the analysis, most of the area under study falls 70% in poor water class and 30% in good water class. Hence, the result revealed that 70% of the groundwater samples of the study area are hardly suitable for drinkingpurposes without water quality management activities.Key words: spatial distribution, GIS, WQI, groundwater quality, Hewane, Tigray, Ethiopi

Thoracic empyema: Cause and Treatment Outcome at Gondar University Teaching Hospital, Northwest Ethiopia

Background: Despite improved antimicrobial therapy and multiple options for drainage of infected pleural space, thoracic empyema (TE) continues to cause significant morbidity and mortality. The objectives of this study were to assess the causes and treatment outcome of patients with thoracic empyema.Methods: Patients aged ≥ 13year with TE who were admitted to Gondar University Teaching Hospital, Northwest Ethiopia, from Nov 1999 to Dec 2007 were included. Retrospectively, medical records were reviewed and demographic and clinical data were collected.Results: Records of 81 patients were analyzed; majority (82%) were below the age 50 year. The mean duration of symptoms prior to presentation and hospital stay was 97.4 and 38days, respectively. HIV/AIDS was detected in 60%. Causes of empyema were pulmonary tuberculosis (56%), pneumonia (36%) and lung abscess (7%). Closed chest tube was inserted in 86% of cases and was successful in 93% of them. Case-fatality was 12% and poor outcome occurred in 26%.Conclusions: Early identification of TE and aggressive management with antibiotics or antituberculosis, drainage with chest tube, and surgical treatment when closed tube drainage fails is recommended to improve the high mortality and morbidity

Factors associated with depressive symptoms in people living with HIV attending antiretroviral clinic at Fitche Zonal Hospital, Central Ethiopia: cross-sectional study conducted in 2012.

BackgroundDepression is one of the most common psychiatric disorders with the prevalence rate ranging from 5% to 10% in the general population and about 60% in people living with human immunodeficiency virus (PLHIV). It has been reported to be more common among women living with HIV. In HIV patients, depression can have negative impacts on their quality of life.ObjectiveThis study was aimed at identifying the prevalence of depressive symptoms and associated factors among PLHIV attending the antiretroviral therapy clinic at Fitche Zonal Hospital.MethodsIt was a cross-sectional study conducted among PLHIV in Fitche Zonal Hospital from February 15 to March 15, 2012. Center for Epidemiologic Studies Depression tool was used to collect data from 390 respondents. Both the bivariate and multivariable logistic regression analyses were carried out and variables with PPResultsOf the total 390 respondents included in the analysis, the prevalence of depressive symptoms was 76.7%, ranging from mild to moderate (33.6%) to major (43.1%), and the highest proportion was observed among individuals with food insecurity accounting for 287 (79.3%). Food insecurity (adjusted odds ratio [AOR] =3.832 [1.575-9.322]), non-ownership of livestock (AOR =2.17 [1.157-4.104]), and opportunistic infections (AOR =5.20 [1.342-20.156]) were significantly associated with depressive symptoms.Conclusion and recommendationsDepressive symptoms were prevalent in PLHIV. Social disparities were important factors of depressive symptoms. Integration of mental health care services with HIV/acquired immune deficiency syndrome-related health care services at all health care levels was necessary. It was recommended that government and non-government organizations should provide assistance to the PLHIV to encourage their involvement in income-generating activities

Evaluation of direct colorimetric MTT assay for rapid detection of rifampicin and isoniazid resistance in Mycobacterium tuberculosis

With the spread of multidrug-resistant tuberculosis (MDR-TB) strains there is an increasing need for new accurate and cost-effective methods for a rapid diagnostic and drug susceptibility testing (DST), particularly in low-income countries where tuberculosis is hyperendemic. A colorimetric assay using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) has been suggested as a promising method for DST, especially to rifampicin. In this study, we standardized and evaluated the MTT assay for a rapid direct detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis strains from sputum specimens using Lowenstein-Jensen (LJ) culture medium as a gold standard. The MTT assay sensitivity, specificity, positive and negative predictive values for rifampicin were 100%, 86%, 100%, 99%, respectively. For isoniazid, the MTT assay had a 100% sensitivity, specificity, positive and negative predictive values. Interestingly, the MTT assay gave interpretable results within two weeks for 94% of the samples compared to 7-14 weeks for LJ media. Overall, an excellent agreement was observed between MTT assay and LJ proportion method (Kappa, 0.91 for rifampicin and 1.00 for isoniazid). In conclusion, the direct colorimetric MTT assay simultaneously detects susceptible and resistant strains of M. tuberculosis within three weeks. It significantly shortens the time required to obtain a DST result and could be a reliable alternative method for rapid detection of drug-resistant TB strains in high-TB-burden resource-limited settings