Prevalence and associated factors of neonatal mortality in North Gondar Zone, Northwest Ethiopia

Background: Childhood mortality is often used as a broad indicator of the social development and health conditions of a country. Updated information on neonatal mortality does thus influence policy, improve services and lead to better health for newborns.Objective: To assess the prevalence of neonatal mortality and associated factors in North Gondar Zone, Ethiopia.Methods: Community based cross-sectional study was carried out from November 2009 to January 2010 in North Gondar Zone. Multi-stage sampling was adopted to get respondents and data was collected using structured questionnaires from 3600 mothers who gave live birth during the year 2005 to 2009.Results: Neonatal mortality was found to be 214 out of 4888 live births with the rate of 43.8 per 1000 live births. The number of pregnancies the women, had (AOR =3.76: 95% CI, 2.73- 5.20), maternal morbidity (AOR =5.43: 95% CI, 2.90-10.17) and neonatal illness (AOR = 3.68: 95% CI, 2.41-5.62) were strongly associated with neonatal mortality. Small size neonates at birth were 2 times more likely to die compared with medium sized ones. Compared with illiterate mothers, secondary and above secondary educated mothers reduced the risk of neonatal deaths by 85% (0.04, 0.51) and 90% (0.01, 0.94), respectively.Conclusion: Neonatal mortality was very high when compared with the national data of Ethiopia. Strategies to improve female education, reducing maternal morbidity, limiting the number of pregnancies, early intervention for neonatal illness, prevention and intervention in low birth weight neonates are recommended to reduce neonatal mortality

Husbandry practices and phenotypic characteristics of indigenous goat populations in Ethiopia.

Abstract: The present study was conducted with the objective to characterize the husbandry practices and phenotypic characteristics of mature Bati, Borana and Short-eared Somali goats kept under traditional management systems so that the information generated can be used in designing breeding programs. The study was covered five districts in four administrative zones of Ethiopia representing Bati (in Oromia Zone) and Kalu (in South Wollo Zone) for Bati goats; Yabello (in Borana Zone) for Borana goats and Shinille and Erer (in Siti Zone) for Short-Eared Somali goats. A total of 345 households interview was made and phenotypic measurements were taken on 601(468 females and 133 males) heads of adult goats with 4 pair of permanent incisors (PPI). However, because of difficulty of finding adequate number of 4PPI sample males, measurements were taken from 2PPI and above males. In this study, in number, goats accounted for 72.01, 50.93 and 47.38% of other livestock species in Siti, around Bati and Borana, respectively. The least square mean (±SE) of goat flock size (44.02±3.33) per household in Siti was significantly (p0.05),whereas Short-eared Somali goats remained significantly (p<0.05) lower for most of the body measurement characteristics. The canonical analysis done on phenotypic measurements also put Bati and Borana goats closer by discriminating Short-eared Somali goat populations. The similarities between Bati and Borena goats and significance divergence of Short-eared Somali goats in phenotypic measurements suggested that the need of further molecular characterization study to validate information from phenotypic characterization. Correlation coefficient was consistently highest between live weight and chest girth in both sexes across the goat populations. Hence, linear measurements could be valuable to estimate live body weight for those farm communities where sensitive weighing scales are not readily available

Immunogenicity and efficacy of non-adjuvant tissue culture-based rabies vaccine produced in Ethiopia

Rabies is 100% fatal, but it is preventable. More than 95% of human rabies cases occur in improperly treated individuals. This is partly due to the fact that modern post-exposure rabies prophylaxis is expensive and therefore not readily available in many endemic regions. Nervous tissue vaccine has been in use for more than 100yrs. These vaccines have now been superseded in purity, potency, immunogenicity and safety. The efficacy and immunogenicity of inactivated tissue culture rabies vaccine, produced in Ethiopia was evaluated. Twelve experimental dogs from local breed were duly conditioned during a quarantine period and assigned to two groups randomly. Animals in group I (cases) were vaccinated subcutaneously with 1 ml of our experimental vaccine. Dogs in group II served as non-vaccinated controls. The immune response of each dog was monitored for 90 days. On the day 90 after final sampling, all dogs were challenged in the masseter muscle with a rabies street virus of canine origin. To evaluate the titer of the rabies virus neutralizing antibodies (VNA), sera were analyzed by Fluorescent Antibody Virus Neutralization (FAVN) Test. Geometric Mean Titers (GMT) to rabies virus was determined at days 7, 15, 21, 30, 60 and 90. Geometric mean titers were equal to 1.59, 1.73, 2.19, 3.58, 3.17 and 3.35 IU/ml respectively. All dogs showed VNA titers higher than the 0.5 IU/ml mandated WHO recommended threshold. All vaccinated dogs, survived the challenge. In contrast, 83.3% of dogs in the control (non-vaccinated group), developed rabies and died. This study indicated that cell culture-based anti-rabies developed inhouse, with no adjuvant is efficacious and immunogenic

Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia

Background: Lymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases. Methodology/Principle findings: A community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months. Conclusions/Significance: This study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most

Linkages between GRACE water storage, hydrologic extremes, and climate teleconnections in major African aquifers

Water resources management is a critical issue in Africa where many regions are subjected to sequential droughts and floods. The objective of our work was to assess spatiotemporal variability in water storage and related controls (climate, human intervention) in major African aquifers and consider approaches toward more sustainable development. Different approaches were used to track water storage, including GRACE/GRACE Follow On satellites for Total Water Storage (TWS); satellite altimetry for reservoir storage, MODIS satellites for vegetation indices, and limited ground-based monitoring. Results show that declining trends in TWS (60–73 km3 over the 18 yr GRACE record) were restricted to aquifers in northern Africa, controlled primarily by irrigation water use in the Nubian and NW Saharan aquifers. Rising TWS trends were found in aquifers in western Africa (23–49 km3), attributed to increased recharge from land use change and cropland expansion. Interannual variability dominated TWS variability in eastern and southern Africa, controlled primarily by climate extremes. Climate teleconnections, particularly El Nino Southern Oscillation and Indian Ocean Dipole, strongly controlled droughts and floods in eastern and southern Africa. Huge aquifer storage in northern Africa suggests that the recent decadal storage declines should not impact the regional aquifers but may affect local conditions. Increasing groundwater levels in western Africa will need to be managed because of locally rising groundwater flooding. More climate resilient water management can be accomplished in eastern and southern Africa by storing water from wet to dry climate cycles. Accessing the natural water storage provided by aquifers in Africa is the obvious way to manage the variability between droughts and floods

Prone ventilation in COVID-19 acute respiratory distress syndrome: Case report of two patients from Ethiopia

The COVID-19 pandemic is one of the largest health crises that the world has ever seen, infecting forty million people and killing more than 1 million to date. The disease has imposed a significant demand on health care resources due to the increased number and severely ill patients visiting facilities each day. Since there is no effective cure for COVID-19, supportive management with oxygen, steroids, anticoagulation, and prone positioning remains the major interventions. Prone ventilation is known to have a mortality benefit in intubated patients with acute respiratory distress syndrome (ARDS). However, studies on its role in intubated patients with COVID-19 ARDS (CARDS) are very scarce in resource-limited settings like Africa. We describe two patients with CARDS who were successfully treated with invasive mechanical ventilation, prone ventilation, and standard supportive care

Countdown to 2015: Ethiopia's progress towards reduction in under-five mortality: 2014 country case study

On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for accelerating health improvements and reducing child deaths

Mortality and Disability-adjusted Life-years (DALYs) for common neglected tropical Diseases in Ethiopia, 1990 to 2015: evidence from the Global Burden of Disease Study 2015

Introduction: Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. Methods: We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), malaria indicator surveys (MICS) and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate malaria and NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). Results: All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699 – 10,080) in 1990 and 3,593 deaths (95% UI: 2051 – 6178) in 2015, a 70% reduction over the 25 years. Age-standardised mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand–1.2 million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand – 1.3 million) in 2015. Age-standardised DALY rates due to all NTDs declined by 30.4%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 – 27.4) in 2015. Age-standardised DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 – 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4 – 59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardised DALY rates for onchocerciasis, schistosomiasis and lymphiatic filariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. Conclusions: Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa.

OBJECTIVE: Systematic review and meta-analysis of published studies of alcohol use among young people (age 15-24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. METHODS: Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I(2) statistic (DerSimonian-Laird). RESULTS: We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20-58%], use in the last month 28% (IQR: 17-37%), use in the last year 26% (IQR: 22-32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3-36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79-85%) and female sex workers (66%; 95%CI: 58-74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63-75%). CONCLUSIONS: Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population