Typhoid in Less Developed Countries: A Major Public Health Concern

Typhoid fever remains a major public health concern in less developed countries. The disease is transmitted through the consumption of food or water contaminated with feces containing Salmonella Typhi. Salmonella is a genus of the family Enterobacteriaceae with over 2450 species. Typhoid is more common in impoverished areas with unsafe drinking water sources and poor sanitation. These problems are further exacerbated by political instabilities, displacement, and war in the regions. Each year, 17.8 million cases of typhoid fever are reported in lower-income countries. Typhoid was expected to be most common in western Africa, followed by a few countries in Central, South, and Southeast Asia. In most cases, the incidence peaked between the ages of under 5 years. Recently, many Salmonella species had developed resistance to several antibiotics which call for serious prevention and control efforts that integrate several high-impact interventions targeting facilities and infrastructure, together with parallel efforts directed at effective strategies for use of typhoid conjugate vaccines. Hence, a multisector collaboration and approach from a different perspective have to be advocated for the containment of typhoid. The clinical and public health concerns and the strategies to stem the growing flows associated with typhoid are going to be discussed

Self-Medication and Contributing Factors Among Pregnant Women Attending Antenatal Care at Public Hospitals of Harar Town, Ethiopia

Background: Self-medication has been increasing in many developing and developed countries. Its use during pregnancy presents a major challenge due to potential undesirable effects on mother and the fetus. So the aim of this study was to assess the prevalence of self-medication and contributing factors, among pregnant women.Methodology: Institution based cross sectional study was conducted among 244 pregnant women attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal Hospital from February to March, 2017. A structured questionnaire based interview was used to collect data from each study subject. Then, data were categorized and analyzed using SPSS version 20 software. Logistic regression analysis was used to determine the significance of the association between the outcome and independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis.Results: The prevalence of self-medication during current pregnancy was 69.4%; out of which, 40.6% uses only herbal medicines to self-medicate. Time saving (50.7%) and prior experience of the drug (25.35%) were the main reasons for self-medication using conventional medicines while fewer side effects (59.86%) and effectiveness (35.92%) were the common reasons for self-medication using herbal medicines. Common cold and headache were among the common indications for self-medication. Friends (28.17%) and the pharmacist/druggist (23.94%) were the commonest source of information for conventional medicines while family/friends (69.72%) and neighbors (26.76%) were the common source of information for herbal medicines. Community drug retail outlets and neighbors were the commonly used sources of conventional medicines; while market place and self-preparation were the common sources of herbal medicines. Previous history of self-medication was significantly associated (P < 0.05) with current self-medication with conventional drugs and being a farmer by occupation and poor monthly income were significantly associated with herbal medicine use during pregnancy (P < 0.05).Conclusion: The prevalence of self-medication during pregnancy was very high in this study which showed a need for public trainings for all women of reproductive age about the risks of inappropriate self-medication

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

Objective: Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods: A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results: Of the total participants, 116 (16.74%, 95% confidence interval: 14.1–19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00–2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64–6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07–2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10–2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14–2.84) were associated with an initial inappropriate antimicrobial use. Conclusion: Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use

Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study

Objective Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia.Design Retrospective follow-up study.Setting Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia.Participants Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021.Primary outcome The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients.Results A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome.Conclusion We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations

In-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia: a retrospective cohort study

ABSTRACTBackground: Acute cardiogenic pulmonary oedema is highly associated with poor in-hospital outcomes. This study aimed to determine the in-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia, from May 1 to 20, 2023.Methods: A retrospective cohort study was employed among 204 patients with acute cardiogenic pulmonary oedema who were admitted between 1st May 2018 and 30th April 2023. The collected data were entered into Excel, and analysed using theSTATA software version 17. The hazard ratio with its 95% confidence interval was used and a P-value < 0.05 was considered a statistically significant association.Results: The overall mortality rate was 17.60 (95% CI: 11.59–26.72) per 1000 person-day observation with mean (±SD) time to death was 2.88 (±2.06) days. Age (AHR: 1.35; 95% CI: 1.04–1.74 for every 10 years), being smoker (AHR: 3.26; 95% CI: 1.05–10.10), having respiratory rate of ≥40 breaths per minute (AHR: 5.46; 95% CI: 1.71–17.45), and having anaemia (AHR: 4.35; 95% CI: 1.23–15.33) were significant predictors of in-hospital mortality.Conclusion: More than one in ten patients in this study died in the hospital. Therefore, special attention needs to be considered for patients with those predictors of in-hospital mortality

Integration of host resistance and fungicides reduced ascochyta blight pressure and minimised yield loss in field pea (Pisum sativum L.) in southern Ethiopia

Ascochyta blight complex causes substantial yield losses and deteriorates seed quality of field pea worldwide. Field experiments were conducted to determine the effectiveness of an integrated approach consisting of host resistance and fungicides to reduce ascochyta blight progression and enhance yield performances of field pea for two seasons at Bonke and Chencha, Southern Ethiopia. Three field pea (Bursa, Burqitu and Tegegnech) varieties and three systemic (Carbonchlor, Matico and Othello-Top) fungicides, along with unsprayed controls, were arranged in a factorial randomised complete block design with three replications. Results showed that fungicide treated plots of each variety recorded the lowest progress rate, while control plots of Bursa, Burqitu and Tegegnech recorded the highest rate parameter (0.67, 0.60 and 0.451 units day−1), respectively at Bonke. Terminal mean severities were reduced by up to 24.6–43.7% and 20.1–43.7% due to fungicide applications over unsprayed plots at Chencha and Bonke, respectively. Moreover, triple applications of Othello-Top enhanced grain yield by 211% (Bursa), 204% (Burqitu) and 140% (Tegegnech) as compared to control plots at Bonke. A related pattern was noticed at Chencha areas. Economically, Burqitu with Othello-Top showed the highest net benefit and benefit–cost ratio of $2.35 × 103 ha−1 and 4.77 (Bonke) and 2.27 × 103 ha−1 and 3.76 (Chencha) in that order of presentation, followed by Matico, and found to be the most profitable management option due to monetary advantage; and it could be suggested for field pea growers