Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study 'Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)'. Data were analysed using SPSS V.23. ORs and 95% CIs and chi (2) tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32-36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration

Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia

BackgroundPreterm infants have high risk of developing growth restriction and long-term complications. Enteral feeding is often delayed in neonatal intensive care units (NICUs) for the fear of feeding intolerance and the associated necrotising enterocolitis, and recent advances in nutritional support are unavailable in low-income countries.ObjectiveThe aim of this study was to assess the incidence and associated factors of extrauterine growth restriction (EUGR) among preterm infants in selected NICUs in Ethiopia.MethodThis was a cross-sectional study involving a subgroup analysis of preterm infants admitted to hospitals, from a multicentre descriptive study of cause of illness and death in preterm infants in Ethiopia, conducted from 2016 to 2018. EUGR was defined as weight at discharge Z-scores <-1.29 for corrected age. Clinical profiles of the infants were analysed for associated factors. SPSS V.23 software was used for analysis with a significance level of 5% and 95% CI.ResultFrom 436 preterm infants included in the analysis, 223 (51%) were male, 224 (51.4%) very low birth weight (VLBW) and 185 (42.4%) small for gestational age (SGA). The mean (SD) of weight for corrected age Z-score at the time of discharge was -2.5 (1.1). The incidence of EUGR was 86.2%. Infants who were SGA, VLBW and longer hospital stay over 21 days had increased risk of growth restriction (p-value<0.01). SGA infants had a 15-fold higher risk of developing EUGR at the time of discharge from hospital than those who were appropriate or large for gestational age (OR (95%CI)=15.2 (4.6 to 50.1).ConclusionThe majority of the infants had EUGR at the time of discharge from the hospital, which indicates suboptimal nutrition. Revision of national guidelines for preterm infants feeding and improvement in clinical practice is highly required

Knowledge and perception towards net care and repair practice in Ethiopia.

BACKGROUND: Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. Although LLINs are presumed to be effective for 3 years under field or programmatic conditions, net care and repair approaches by users influence the physical and chemical durability. Understanding how knowledge, perception and practices influence net care and repair practices could guide the development of targeted behavioural change communication interventions related to net care and repair in Ethiopia and elsewhere. METHODS: This population-based, household survey was conducted in four regions of Ethiopia [Amhara, Oromia, Tigray, Southern Nations Nationalities Peoples Region (SNNPR)] in June 2015. A total of 1839 households were selected using multi-stage sampling procedures. The household respondents were the heads of households. A questionnaire was administered and the data were captured electronically. STATA software version 12 was used to analyse the data. Survey commands were used to account for the multi-stage sampling approach. Household descriptive statistics related to characteristics and levels of knowledge and perception on net care and repair are presented. Ordinal logistic regression was used to identify factors associated with net care and repair perceptions. RESULTS: Less than a quarter of the respondents (22.3%: 95% CI 20.4-24.3%) reported adequate knowledge of net care and repair; 24.6% (95% CI 22.7-26.5%) of the respondents reported receiving information on net care and repair in the previous 6 months. Thirty-five per cent of the respondents (35.1%: 95% CI 32.9-37.4%) reported positive perceptions towards net care and repair. Respondents with adequate knowledge on net care and repair (AOR 1.58: 95% CI 1.2-2.02), and those who discussed net care and repair with their family (AOR 1.47: 95% CI 1.14-1.89) had higher odds of having positive perceptions towards net care and repair. CONCLUSIONS: The low level of reported knowledge on net care and repair, as well as the low level of reported positive perception towards net repair need to be addressed. Targeted behavioural change communication campaigns could be used to target specific groups; increased net care and repair would lead to longer lasting nets

Outcome of preterm twins compared to preterm singleton neonates, a multicenter prospective observational study in Ethiopia

Background: In recent decades there has been a major increase in multiple birth rates, and the rate of twining vary from 6-9 per thousand life births to 20 per thousand live births across differ-ent areas of the world. Many studies have demonstrated higher neonatal and perinatal mortality and morbidity rates in twin deliveries compared to singleton births. This study was aimed to com-pare the outcomes of preterm twins and preterm singletons.Methods: A prospective, observational multicenter study was conducted from July 2016 to May 2018 in five tertiary hospitals in Ethiopia. All preterm, liveborn infants born at or transferred at less than 7 days of life to one of the study hospitals with an estimated gestational age below 37 weeks were included.Results: A total of 3,703 preterm neonates admitted to participating neonatal intensive care units were included in the study, of which 1171(31.6%) were twins. After adjusting for birth weight and gestational age, the mortality rate for preterm singletons of 31.0% was higher than the mortality rate for preterm twins of 24.8%, which was statistically significant (p-value = 0.001), OR of 1.37 (95% CI: 1.15 to 1.64). The study also identified an inverse relationship between birth weight and gestational age, and mortality. Male singletons were more likely to die than male twins (440 (32.4%) vs. 141 (23.4%); AOR 1.56 (95% CI: 1.22, 1.99); p=0.001)Conclusion: Our study showed that the mortality of a singleton preterm infant was significantly higher than the mortality of a preterm twin infan

A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol

Background With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. Methods This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. Discussion This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality

Children under Five from Houses of Unclean Fuel Sources and Poorly Ventilated Houses Have Higher Odds of Suffering from Acute Respiratory Infection in Wolaita-Sodo, Southern Ethiopia: A Case-Control Study

Background. Acute respiratory tract infection is the most common illness in childhood. Ninety-five percent (99% of rural and 80% of urban) of households in Ethiopia primarily use solid fuel for cooking. This study investigated the effect of household fuel use and house ventilation on acute respiratory infection in children, Wolaita-Sodo, Southern Ethiopia. Methods. A community based case-control study design was used, covering a sample of 1144 children with ratio of 1 : 3 (286 cases and 858 controls) aged between 0 and 59 months. A case was defined as a child who suffered from cough, followed by short, rapid breathing in the last two weeks that preceded the survey, while control was defined as a child who had not any of the respiratory infection signs and symptoms. Study subjects were recruited after a census from households. Data were entered using EpiData version 3.1 and analyzed using SPSS version 21. Results. The proportion of children aged 1–3 years and 3–5 years was 76% and 24%, respectively. Two-thirds of children lived in households that used solid fuels for cooking (charcoal 62.76% and biomass 24.73%). The majority of households (83%) used open/traditional three-stone stoves. Unclean fuel users for cooking (AOR = 2.09, 95% CI 1.03–4.22), poorly ventilated houses (AOR = 4.32, 95% CI 2.61–7.15), large family size (AOR = 1.85, 95% CI 1.31–2.62), and carrying of a child while cooking (AOR = 1.66, 95% CI 1.18–2.34) were significant risk factors of acute respiratory infection in children under five. Conclusions. Children from houses of unclean fuel sources and poorly ventilated houses were more likely to be affected by acute respiratory infection. Using clean energy sources and improved stoves is highly suggested

Mastering Kubernetes: automating container deployment and management

Additional file 2. Medicinal plant families, species, local name, habit, parts used, preparation methods and other medicinal values of plants used for the treatment of malaria in Ethiopia

Epidemiology of visceral leishmaniasis in Shebelle Zone of Somali Region, eastern Ethiopia

Abstract Background Visceral leishmaniasis (VL), a vector-borne disease caused by species of the L. donovani complex, has (re)-emerged in Ethiopia during the last two decades and is currently of increasing public health concern. However, very little is known about VL epidemiology in the Somali Region of Ethiopia. The aim of this study was to provide detailed epidemiological information on seroprevalence, associated factors and incriminated vectors of VL in Shebelle Zone and Ethiopian Somali Region in general. Methods A cross-sectional epidemiological study was conducted between March and May 2016 in Gode and Adadle districts of Shebelle Zone, Ethiopian Somali Region. Two-stage semi-random sampling was applied for selecting study participants for the field survey. The study included structured questionnaire interviews, serological assays (rK39-immunochromatographic test), ELISA and entomological surveys. Results From a total of 361 participants, 57 (15.8%) were seropositive for VL including 46 (12.7%) rK39 positive and 11 (3.0%) positive by both rK39 and ELISA. VL seroprevalence was higher (P < 0.001) in Adadle (31.1%) compared to Gode (12.7%) district. The VL seroprevalence rate was higher in females than in males [rK39 (17.2 vs 14.0%) and ELISA (3.4 vs 2.5%)]. Children under the 15 years of age were the most highly affected group [rK39 (20.4%) and ELISA (4.4%)]. Increased VL risk was associated with presence of termite hills, study district, outdoor sleeping, Acacia trees and domestic animals [odds ratio (95% confidence interval): 12.58 (5.911–26.763), 5.40 (2.90–10.07), 5.31 (2.283–12.364), 2.37 (1.1190–4.728) and 0.199 (0.097–0.410), respectively]. The entomological survey identified 74 Phlebotomus [P. (Larroussius) orientalis (52/74), P. (Anaphlebotomus) rodhaini (14/74), P. (Paraphlebotomus) sergenti (8/74)] and 11 Sergentomyia sand flies. The average frequency of P. orientalis (3.06 ± 0.66) collected by all traps per night was higher than that of other species. The average frequency of total and specific (P. orientalis) female sand flies was higher in Adadle (1.89 ± 0.423 vs 1.11 ± 0.309) than in Gode (0.62 ± 0.324 vs 0.38 ± 0.183) district. The highest mean numbers of total (8 ± 1.5) and P. orientalis (6 ± 0.913) sand flies were collected in termite hills. Conclusions The present findings revealed potential new VL-transmission foci in the study districts. Therefore, the need for parasitological and molecular characterization of the parasite in humans and vector sand flies is of paramount importance to confirm transmission

Sepsis : emerging pathogens and antimicrobial resistance in Ethiopian referral hospitals

Background Sepsis due to multidrug resistant (MDR) bacteria is a growing public health problem mainly in low-income countries. Methods A multicenter study was conducted between October 2019 and September 2020 at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. A total of 1416 patients clinically investigated for sepsis were enrolled. The number of patients from Tikur Anbessa, Yekatit 12, Dessie and Hawassa hospital was 501, 298, 301 and 316, respectively. At each study site, blood culture was performed from all patients and positive cultures were characterized by their colony characteristics, gram stain and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). Antimicrobial resistance pattern of bacteria was determined by disc diffusion. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value &lt; 0.05 was considered as statistically significant. The data was analyzed using SPSS version 25. Results Among 1416 blood cultures performed, 40.6% yielded growth. Among these, 27.2%, 0.3% and 13.1%, were positive for pathogenic bacteria, yeast cells and possible contaminants respectively. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%) and E. coli (12.4%) were the most frequent. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie. Rare isolates (0.5% or 0.2% each) included Leclercia adecarboxylata, Raoultella ornithinolytica, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia, Kosakonia cowanii and Lelliottia amnigena. Enterobacteriaceae most often showed resistance to ampicillin (96.2%), ceftriaxone (78.3%), cefotaxime (78%), cefuroxime (78%) and ceftazidime (76.4%). MDR frequency of Enterobacteriaceae at Hawassa, Tikur Anbessa, Yekatit 12 and Dessie hospital was 95.1%, 93.2%, 87.3% and 67.7%, respectively. Carbapenem resistance was detected in 17.1% of K. pneumoniae (n = 111), 27.7% of E. cloacae (n = 22) and 58.8% of Acinetobacter baumannii (n = 34). Conclusion Diverse and emerging gram-negative bacterial etiologies of sepsis were identified. High multidrug resistance frequency was detected. Both on sepsis etiology types and MDR frequencies, substantial variation between hospitals was determined. Strategies to control MDR should be adapted to specific hospitals. Standard bacteriological services capable of monitoring emerging drug-resistant sepsis etiologies are essential for effective antimicrobial stewardship