Respiratory Limitations to Exercise Tolerance and Performance in Obese Adolescent Patients

Obese adolescents (OB) have an increased O2 cost of exercise, attributable in part to an increased O2 cost of breathing. The increased O2 cost of breathing could entail a \u201ccompetition\u201d between respiratory and locomotor muscles for the finite available O2, leading to fatigue and premature exhaustion. This would contribute to the inactivity which represents one of the main causes of obesity, impeding the increased level of physical activity which is one of the cornerstones of the treatment of the disease. In order to interrupt this vicious circle, we followed two approaches, attempting to relieve the respiratory limitation in obese adolescents performing cycling/walking exercises. In the first approach, respiratory muscles were acutely unloaded via normoxic helium-O2 (HeO2). Helium [He] has a lower density compared to nitrogen, and thereby HeO2 breathing requires less respiratory muscle work than air breathing. This unloading lowered the O2 cost of exercise and perceived exertion during moderate- and heavy-intensity cycling of relatively short duration (12 min). Following these findings, respiratory muscles were acutely unloaded by switching the inspired gas from ambient air (AIR) to normoxic HeO2 (AIR+HeO2) during constant work rate (CWR) cycling to exhaustion, in order to specifically evaluate the effects of the proposed intervention on exercise tolerance. The intervention extended exercise duration/improved exercise tolerance during both moderate (below the gas exchange threshold,GET) cycling exercises. In the second approach, a standardized program of respiratory muscle endurance training (RMET) was superimposed on a standard multidisciplinary body mass reduction program; RMET decreased perceived exertion and O2 cost of exercise during heavy-, but not during moderate-intensity cycling exercise, and improved peak cycling capacity. We then evaluated the hypothesis that the benefits of RMET on the O2 cost of exercise and exercise tolerance would be more pronounced during walking on a treadmill compared to the effects described during cycling, and/or could be observed also at low intensities. Indeed, in OB a 3-wk RMET program markedly lowered the O2 cost of moderate- and heavy-intensity walking and improved exercise tolerance. By contrasting the vicious circle of obesity \u2192 early fatigue \u2192 reduced exercise tolerance \u2192 reduced physical activity \u2192 obesity, the intervention more specifically directed to the respiratory function, such as RMET programs, could represent a useful adjunct in the control of obesity. Longer periods of RMET should be investigated

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia

Background Early diagnosis and treatment are one of the key strategies of tuberculosis control globally, and there are strong efforts in detecting and treating tuberculosis cases in Ethiopia. Smear microscopy examination has been a routine diagnostic test for pulmonary tuberculosis diagnosis in resource-constrained settings for decades. Recently, many countries, including Ethiopia, are scaling up the use of Gene Xpert without the evaluation of the cost and cost-effectiveness implications of this strategy. Therefore, this study evaluated the cost and cost-effectiveness of Gene Xpert (MTB/RIF) and smear microscopy tests to diagnosis tuberculosis patients in Ethiopia. Methods We compared the costs and cost-effectiveness of tuberculosis diagnosis using smear microscopy and Gene Xpert among 1332 patients per intervention in the Arsi zone. We applied combinations of top-down and bottom-up costing approaches. The costs were estimated from the health providers’ perspective within one year (2017–2018). We employed “cases detected” as an effectiveness measure, and the incremental cost-effectiveness ratio was calculated by dividing the changes in cost and change in effectiveness. All costs and incremental cost-effectiveness ratio were reported in 2018 US$. Results The unit cost per test for Gene Xpert was USD 12.9 whereas it is USD 3.1 for AFB smear microscopy testing. The cost per TB case detected was USD 77.9 for Gene Xpert while it was USD 55.8 for the smear microscopy method. The cartridge kit cost accounted for 42% of the overall Gene Xpert’s costs and the cost of the reagents and consumables accounted for 41.3% (USD 1.3) of the unit cost for the smear microscopy method. The ICER for the Gene Xpert strategy was USD 20.0 per tuberculosis case detected. Conclusion Using Gene Xpert as a routine test instead of standard care (smear microscopy) can be potentially cost-effective. In the cost scenario analysis, the price of the cartridge, the number of tests performed per day, and the life span of the capital equipment were the drivers of the unit cost of the Gene Xpert method. Therefore, Gene Xpert can be a part of the routine TB diagnostic testing strategy in Ethiopia.publishedVersio

Participatory Epidemiological Studies of Major Trade Constraint Diseases of Goats in Selected Districts of Afar Region

In Afar pastoral area, livelihoods depend, at least in part, on livestock. Small ruminants made by far the greatest contribution to livestock-based livelihoods in all study districts. This study was conducted to assess and analyze trade sensitive disease problems of goats of Afar pastoral community. Information was gathered from pastoralists from June 2013- June 2014. At producers’ level, 12 focus group discussion and interview with 291 pastoralists were held at the selected four districts of Afar pastoral areas. Majority of markets in Afar region performed below their capacity. About 72.2% of pastoralist offers goats for sale to meet their urgent needs at any time during the year. Majority (51.9%) of the producers have no specific target to sale their goats. Animal characteristics in terms of health, quality and other criteria required by exporters were known only by 7.6% of the producers. Afars’ sheep are the most demanded by exporters next to Somali black head but from total shoat presented for sale, sheep accounts only 20%. Majority of producers (40.9%) indicated that they present young male for sale and 28.2% of producers presented culled female shoat for sale. Pastoralist motioned PPR, Pasteurellosis, goat pox, External parasites and CCPP as most important diseases in terms of impact on livelihoods. There was no veterinarian performing pre-purchase inspection and selection for quality assurance and certification for live shoat at various points in market chain. Quarantine centers listed PPR, pasteurellosis, CCPP, goat pox and external parasites most important disease of shoat in terms of impact on businesses. Most of the diseases motioned by quarantine centers as major diseases are also the major diseases prevailing at the producer level. Keywords: Trade sensitive, PPR, CCPP, Goat Pox, Producer, Quarantine, key informant

Participatory Assessment of Trade Limiting Diseases of Small Ruminants in Afar’s Small Ruminants’ Export Market Chain

Participatory epidemiological study was carried out from June 2013 to June 2014 to identify most economically important trade sensitive diseases which constraints trade and to quantify and rank the major diseases along the small ruminant market chain of export of small ruminants originated from Afar pastoral community.  A retrospective case control study design was used to collect data on trade sensitive disease problems in the market chains using epidemiological techniques of semi-structured interview, disease ranking and matrix scoring. Information was collect from producers, key informants and participants in the shoat export market chains. Purposive sampling was used to select 291 producers, 12 focus groups of traders and key informants that held in four districts selected districts with their respective markets and four quarantine stations to generate information about health problems along the market chain. Collected data was coded, managed and validated in excel spread sheet. The level of agreement between informant groups was assessed using the Kendal’s coefficient of concordance (W) calculated using the Statistical Package for the Social Sciences (SPSS, 2007). About 72.2% of pastoralist offers shoat for sale to meet their urgent needs at any time during the year. Majority (51.9%) of the producers have no specific target to sale their shoat. Animal characteristics in terms of health, quality and other criteria required by importers were known only by 7.6% of the producers. Afars’ sheep are the most demanded by importers next to Somali black head but from total shoat presented for sale, sheep accounts only 20%. Majority of producers (40.9%) indicated that they present young male for sale and 28.2% of producers presented culled female shoat for sale. Pastoralist motioned PPR, Pasteurellosis, sheep pox, External parasite, Ovine Faciolosis and CCPP as most important diseases in terms of impact on livelihoods. Quarantine centers listed PPR, pasteurellosis, CCPP, sheep pox and external parasite most important disease of shoat in terms of impact on businesses. Most of the diseases motioned by quarantine centers as major diseases are also the major diseases prevailing at the producer level. Keywords: Trade sensitive, PPR, CCPP, Shoat Pox, Producer, Quarantine, key informan

Equity in public health spending in Ethiopia: a benefit incidence analysis

Inequality in access and utilization of health services because of socioeconomic status is unfair, and it should be monitored and corrected with appropriate remedial action. Therefore, this study aimed to estimate the distribution of benefits from public spending on health care across socioeconomic groups in Ethiopia using a benefit incidence analysis. We employed health service utilization data from the Living Standard Measurement Survey, recurrent government expenditure data from the Ministry of Finance and health services delivery data from the Ministry of Health’s Health Management Information System. We calculated unit subsidy as the ratio of recurrent government health expenditure on a particular service type to the corresponding number of health services visits. The concentration index (CI) was applied to measure inequality in health care utilization and the distribution of the subsidy across socioeconomic groups. We conducted a disaggregated analysis comparing health delivery levels and service types. Furthermore, we used decomposition analysis to measure the percentage contribution of various factors to the overall inequalities. We found that 61% of recurrent government spending on health goes to health centres (HCs), and 74% was spent on outpatient services. Besides, we found a slightly pro-poor public spending on health, with a CI of −0.039, yet the picture was more nuanced when disaggregated by health delivery levels and service types. The subsidy at the hospital level and for inpatient services benefited the wealthier quintiles most. However, at the HC level and for outpatient services, the subsidies were slightly pro-poor. Therefore, an effort is needed in making inpatient and hospital services more equitable by improving the health service utilization of those in the lower quintiles and those in rural areas. Besides, policymakers in Ethiopia should use this evidence to monitor inequity in government spending on health, thereby improving government resources allocation to target the disadvantaged better.publishedVersio

Cost-Effectiveness of Saxagliptin Compared With Glibenclamide as a Second-Line Therapy Added to Metformin for Type 2 Diabetes Mellitus in Ethiopia

Background. Metformin is a widely accepted first-line pharmacotherapy for patients with type 2 diabetes mellitus (T2DM). Treatment of T2DM with glibenclamide, saxagliptin, or one of the other second-line treatment agents is recommended when the first-line treatment (metformin) cannot control the disease. However, there is little evidence on the additional cost and cost-effectiveness of adding second-line drugs. Therefore, this study aimed to estimate the cost-effectiveness of saxagliptin and glibenclamide as second-line therapies added to metformin compared with metformin only in T2DM in Ethiopia. Methods. This cost-effectiveness study was conducted in Ethiopia using a mix of primary data on cost and best available data from the literature on the effectiveness. We measured the interventions’ cost from the providers’ perspective in 2019 US dollars. We developed a Markov model for T2DM disease progression with five health states using TreeAge Pro 2020 software. Disability-adjusted life year (DALY) was the health outcome used in this study, and we calculated the incremental cost-effectiveness ratio (ICER) per DALY averted. Furthermore, one-way and probabilistic sensitivity analysis were performed. Results. The annual unit cost per patient was USD 70 for metformin, USD 75 for metformin + glibenclamide, and USD 309 for metformin + saxagliptin. The ICER for saxagliptin + metformin was USD 2259 per DALY averted. The ICER results were sensitive to various changes in cost, effectiveness, and transition probabilities. The ICER was driven primarily by the higher cost of saxagliptin relative to glibenclamide. Conclusion. Our study revealed that saxagliptin is not a cost-effective second-line therapy in patients with T2DM inadequately controlled by metformin monotherapy based on a gross domestic product per capita per DALY averted willingness-to-pay threshold in Ethiopia (USD 953).publishedVersio

Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

Background: Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods: Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results: The cost of test per client for facility-based, stand-alone and mobile-based VCT was USD 5.06, USD 6.55 and USD 3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were USD 158.82, USD 150.97 and USD 135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion: Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.publishedVersio

A-5-year analysis of pediatric brain tumors in a tertiary care center, in a sub-saharan African country.

Background: Tumors of the central nervous system (CNS) are the second most common group of cancers in childhood, exceeded by the leukemias. It is the most common pediatric solid tumor accounting for 20% of all childhood malignancies. The pattern and outcome of these tumors in children has not been studied in Ethiopia. This study aimed to assess the epidemiology and out-come of pediatric brain tumors in a tertiary care center in Addis Ababa, Ethiopia.Methods: A retrospective review of medical records of children less than 15 years of age diag-nosed with primary brain tumor in Tikur Anbessa Specialized Hospital Department of pediatrics from January 1, 2014 to January 1, 2019 was done. Treatment outcome was assessed clinically based on resolution of symptoms and absence of neurologic disabilityResults: There were 86 children with the diagnosis of brain tumor in the study period and 49/86 (57%) were males and the male to female ratio was 1.5:1. The age at presentation ranges from 2.4-14 years (mean 7.1 years). Headache was the commonest presentation among 65/86 (75.5%) children while early morning vomiting accounted for 57/86 (66.2%). Ataxia and gait abnormality contributed to 42/86 (48.8%). Among the 41 children whose pathologic result was available, the commonest tumor was medulloblastoma 13/41 (31.7%), followed by astrocytoma 8/41 (19.5 %) and craniopharyngioma 5/41 (12.1%). Six months and 5 years survival was 40% (35/86) and 2.3% (2/86) respectively.Conclusion: Medulloblastoma and astrocytoma were common brain tumors in children, we had the longest PSI and as a result, very low survival which calls for early diagnosis and treatment

Validity and reliability of the Amharic version of the Schwartz Center Compassionate Care Scale

Background Compassionate care is the sensitivity shown by health care providers to understand another person’s suffering and a willingness to help and to promote the well being of that person. Although monitoring of compassionate care is key to ensuring patient-centered care, there is no validated tool in the Ethiopian context that can be applied to measure compassionate care. Therefore, this study aimed to assess the structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® (SCCCS) in the Ethiopian context. Methods The structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® were investigated in a sample of 423 oncology patients in the adult Oncology department of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The internal consistency of the instrument was examined based on Cronbach’s alpha coefficient, and the structural validity was evaluated by subjecting the items of the instrument to factor analysis. Statistical analysis was made using SPSS version 23.0. Results We have found that the Schwartz Center Compassionate Care scale is a two-factor structure (recognizing suffering and acting to relieve suffering). The scale has high overall scale reliability, which was 0.88, and subscale reliability of 0.84 for both recognizing suffering and acting to relieve suffering factors. Conclusions The Schwartz Center Compassionate Care Scale has high internal consistency and acceptable structural validity value. The tool can be used to measure compassionate care practice in the Ethiopian context.publishedVersio

Is universal health coverage affordable? Estimated costs and fiscal space analysis for the Ethiopian Essential Health Services Package

Estimating the required resources for implementing an essential health services package (EHSP) is vital to examine its feasibility and affordability. This study aimed to estimate the financial resources required to implement the Ethiopian EHSP from 2020 to 2030. Furthermore, we explored potential alternatives to increase the fiscal space for health in Ethiopia. We used the OneHealth Tool (OHT) to estimate the costs of expanding the EHSP service provision in the public sector in Ethiopia. Combinations of ingredient-based bottom-up and program-based summary costing approaches were applied. We predicted the fiscal space using assumptions for economic growth, government resource allocations to health, external aid for health, the magnitude of out-of-pocket expenditure, and other private health expenditures as critical factors affecting available resources devoted to health. All costs were valued using 2020 US dollars (USD). To implement the EHSP, 13.0 billion USD (per capita: 94 USD) would be required in 2030. The largest (50–70%) share of estimated costs was for medicines, commodities, and supplies, followed by human resources costs (10–17%). However, the expected available resources based on a business-as-usual fiscal space estimate would be 63 USD per capita for the same year. Therefore, the gap as a percentage of the required resources would be 33% in 2030. The resources needed to implement the EHSP would increase steadily over the projection period due mainly to increases in service coverage targets over time. Allocating gains from economic growth to increase the total government health expenditure could partly address the gap.publishedVersio