Improving sensitivity of oral fluid testing in IgG prevalence studies: application of mixture models to a rubella antibody survey

A method for the analysis of age-stratified antibody prevalence surveys is applied to a previously reported survey of antibody to rubella virus using oral fluid samples in which the sensitivity of the assay used was shown to be compromised. The age-specific distribution of the quantitative results of antibody tests using oral fluids is modelled as a mixture of strong positive, weak positive and negative components. This yields maximum likelihood estimates of the prevalence at each age and demonstrates that, when used in conjunction with mixture modelling techniques, the results of antibody prevalence studies using oral fluids accurately reflect those obtained using sera

Cost-effectiveness analysis of clinical specialist outreach as compared to referral system in Ethiopia: an economic evaluation

BACKGROUND: In countries with scarce specialized Human resource for health, patients are usually referred. The other alternative has been mobilizing specialists, clinical specialist outreach. This study examines whether clinical specialist outreach is a cost effective way of using scarce health expertise to provide specialist care as compared to provision of such services through referral system in Ethiopia. METHODS: A cross-sectional study on four purposively selected regional hospitals and three central referral hospitals was conducted from Feb 4-24, 2009. The perspective of analysis was societal covering analytic horizon and time frame from 1 April 2007 to 31 Dec 2008. Data were collected using interview of specialists, project focal persons, patients and review of records. To ensure the propriety standards of evaluation, Ethical clearance was obtained from Jimma University. RESULTS: It was found that 532 patients were operated at outreach hospitals in 125 specialist days. The unit cost of surgical procedures was found to be ETB 4,499.43. On the other hand, if the 125 clinical specialist days were spent to serve patients referred from zonal and regional hospitals at central referral hospitals, 438 patients could have been served. And the unit cost of surgical procedures through referral would have been ETB 6,523.27 per patient. This makes clinical specialist outreach 1.45 times more cost effective way of using scarce clinical specialists' time as compared to referral system. CONCLUSION: Clinical specialist outreach is a cost effective and cost saving way of spending clinical specialists' time as compared to provision of similar services through referral system

Sero-epidemiology of rubella in the urban population of Addis Ababa Ethiopia

We 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 5·2 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 0·3 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

Assessment of laboratory logistics management information system practice for HIV/AIDS and tuberculosis laboratory commodities in selected public health facilities in Addis Ababa, Ethiopia

Introduction: Logistics management information system for health commodities remained poorly implemented in most of developing countries. To assess the status of laboratory logistics management information system for HIV/AIDS and tuberculosis laboratory commodities in public health facilities in Addis Ababa. Methods: A cross-sectional descriptive study was conducted from September 2010-January 2011 at selected public health facilities. A stratified random sampling method was used to include a total of 43 facilities which, were investigated through quantitative methods using structured questionnaires interviews. Focus group discussion with the designated supply chain managers and key informant interviews were conducted for the qualitative method. Results: There exists a well-designed logistics system for laboratory commodities with trained pharmacy personnel, distributed standard LMIS formats and established inventory control procedures. However, majority of laboratory professionals were not trained in LMIS. Majority of the facilities (60.5%) were stocked out for at least one ART monitoring and TB laboratory reagents and the highest stock out rate was for chemistry reagents. Expired ART monitoring laboratory commodities were found in 25 (73.5%) of facilities. Fifty percent (50%) of the assessed hospitals and 54% of health centers were currently using stock/bin cards for all HIV/AIDS and TB laboratory commodities in main pharmacy store, among these only 25% and 20.8% of them were updated with accurate information matching with the physical count done at the time of visit for hospitals and health centers respectively. Conclusion: Even though there exists a well designed laboratory LMIS, keeping quality stock/bin cards and LMIS reports were very low. Key ART monitoring laboratory commodities were stock out at many facilities at the day of visit and during the past six months. Based on findings, training of laboratory personnel's managing laboratory commodities and keeping accurate inventory control procedures were recommended.Key words: Logistics management information system, stock outs, laboratory commoditie

The prospective association between obesity and major depression in the general population:does single or recurrent episode matter?

Background: Obesity and major depressive disorder (MDD) are important public health problems. MDD is a heterogeneous disorder and the direction of its association with obesity remains unclear. Evidence grows that recurrent MDD (MDD-R) differs in etiology and prognosis from single episode MDD (MDD-S), which could affect associations with obesity. However, evidence on this differential effect is lacking. The aim of this study was to examine the direction of the association between obesity and MDD, single or recurrent episode. Methods: A longitudinal study was performed in a cohort of 1094 participants of the PREVEND study, on whom data were collected at baseline and at an average 2-year follow-up. MDD-S and MDD-R were assessed by the Composite International Diagnostic Interview (CIDI 2.1). Obesity was defined as Body Mass Index >= 30 kg/m(2). Binary logistic regression analyses were conducted to examine whether obesity predicts MDD-S/MDD-R or vice versa, adjusted for potential confounders. Results: Prospective analyses showed that BMI at baseline was associated with the onset of MDD-R (Odds ratio, OR = 1.32; 95% confidence interval, 95% CI: 1.11; 1.57) during 2-year follow-up, but not with the onset of MDD-S (OR = 0.98; 95% CI: 0.89; 1.07). Obesity at baseline was not associated with the onset of MDD-S during follow-up (OR = 0.75; 95% CI: 0.25; 2.30), but associated with the onset of MDD-R during follow-up (OR = 11.63; 95% CI: 1.05; 128.60). Neither MDD-S nor MDD-R were associated with the development of obesity during 2-year follow-up (OR = 1.67, 95% CI: 0.64; 4.29 and OR = 2.32, 95% CI: 0.82; 6.58, respectively). Conclusions: Our findings add to the available evidence that obesity might specifically be associated with the onset of multiple episodes of major depression (MDD-R). Although the reverse association was not found, MDD-R tends to be also associated with subsequent development of obesity, but larger studies are needed to fully assess this issue. The heterogeneity of MDD should be considered when examining the effect of obesity on MDD

Modeling the response of tropical highland herbaceous grassland species to climate change:the case of the Arsi mountains of Ethiopia

AbstractGlobal warming is forcing plant and animal species to respond either through pole-ward or upslope migration to adjust to temperature increases, and grassland communities are not an exception to this phenomenon. In this study, we modeled the response of herbaceous species of grasslands within the Arsi Mountains in Ethiopia under no-migration and with migration scenarios to the projected 4.2°C increase of temperature by 2090 (under the A2 emission scenario). For 67 species of grasses and legumes, we determined the current and predicted altitudinal limits and calculated current and projected area coverage using a Digital Elevation Model. The results indicated that the projected warming significantly reduced altitudinal ranges and habitat areas of all the species studied. All the studied species faced range contraction and habitat loss with range shift gaps among forty two species under the no-migration scenario. With the migration scenario, however, the forty two species with range shift gaps are predicted to benefit from at least some habitat area retention. Between growth forms, legumes are predicted to lose significantly more habitat area than grasses under the no-migration scenario while no significant difference in habitat area loss is predicted under the migration scenario. It can be concluded that management options are required to facilitate upslope species migration to survive under the warming climate. This could involve leaving suitable dispersal corridors and assisted colonization depending on species behavior and level of extinction risk predicted under the projected warming

Improvement of Grassland Through Community Participation in the Middle AwashValley of Ethiopia

The natural resources of the grassland in the middle Awash valley of Ethiopia are subjected to competing claims: development to generate revenue for the state, conservation of wildlife and wilderness areas, as well as use for local production. The combination of climatic conditions causing drought and the over use of the natural resource can be cited as the primary cause of grassland deterioration in the area. Since the problems of the grasslands are complex and multi-dimensional, they are not amenable to quick and easy fixes. Hence, if sustainable progress is to be achieved, the responsibility for change must be in the hands of the communities and household themselves. Pastoral communities, in collaboration with CARE-Ethiopia, local government and other partner NGOs embarked on grassland improvement activities that were based on traditional activities. The objective of this study was to assess the condition of the traditionally-improved grazing lands

Tourism Potential & Challenges for Islamic Monastery Heritage Sites in Ethiopia: Tiru Sina Mosque

The main intent of this study is to investigate unusual Islamic monastery heritage sites by focusing on the potential resources and challenges for religious tourism development at Tiru Sina Mosque. To meet this objective a qualitative approach was utilised and data were collected through interviews with elderly religious fathers in addition to culture and tourism officers. Additional focus groups, discussions and deep personal observations were conducted. As the findings reveal, Tiru Sina Mosque is a unique Islamic monastic site with great potential for religious tourism development. This unique Islamic monastery heritage site has socio-cultural, economic, historical, religious and aesthetic values. The study also confirmed, even though the area is rich in cultural heritage, there are serious challenges that affect its development. The major problems are lack of awareness, poor handling systems for heritage, lack of infrastructural development, absence of coordination among stakeholders, shortage of skilled professionals, lack of cooperation and partnership among different stakeholders, heritage destruction and lack of conservation, and lack of risk management

Consumer drivers and barriers of WASH products use in rural Ethiopia

In Ethiopia, the coverage of basic WASH facilities is very low. In response, government of Ethiopia and its development partners have been using sanitation marketing to promote and sell WASH products. Qualitative in-depth interview with households, supply chain actors, and stakeholders were conducted in four regions of Ethiopia to learn about current product use behaviours. The result showed presence of any latrine was related to greater awareness about importance to health. Financial constraints, unavailability of construction materials were major barriers to possession of latrines. Word of mouth was the dominant source of information on WASH products, with health extension workers being a respected source. The major challenges of supply chain actors at district level were finance, inadequate working space, and lack of business development skills. Lack of regular WASH products supply system at community level and lack of profound awareness about health benefit were the priority constrains to access latrines