Prevalence of Giardiasis and Cryptosporidiosis among children in relation to water sources in Selected Village of Pawi Special District in Benishangul-Gumuz Region, Northwestern Ethiopia

Introduction: Giardia lamblia and Cryptosporidium parvum are implicated in many waterborne disease outbreaks in different parts of the world.Objective: This study was conducted to assess the prevalence of these two parasites among children below 14 years old that drink water from different sources.Methods: Single stool specimens were collected from a total of 384 children in Almu, K2V24, and K2V23/24 villages, Pawi Special District, northwestern Ethiopia, and microscopically examined for Giardia cyst/trophozoites and Cryptosporidium oocysts. For identification of Cryptosporidium parvum the modified Ziehl-Neelsen staining method was used. Giardia lamblia was detected using direct microscopy based on wet mount and formalin-ether concentration techniques.Results: Out of the 384 children examined, 102 (26.6%) and 31 (8.1%) were found positive for G. lamblia and C .parvum infection, respectively. Prevalence of giardiasis in female children was significantly higher than in the males. However, no significant association was observed for infection of cryptosporidiosis between the two sexes. G.lamblia and C. parvum infection prevalence was not significantly different among the different age groups. On the other hand, the prevalence of G. lamblia and C. parvum was associated with the source of drinking water with more cases ofgiardiasis detected in study participants using water from unprotected water sources than those using the “protected” water. Contrary to this, more cases of cryptosporidiosis were detected in those using “protected” water sources.Conclusion: From the findings of the study one can conclude that providing well protected and treated drinking water should be considered a priority for reducing the existing high prevalence of giardiasis and cryptosporidiosis in the study area

Factors in the suboptimum performance of rural water supply systems in the Ethiopian highlands

Access to safe drinking water services in the Ethiopian Highlands is one of lowest worldwide due to failure of water supply services shortly after construction. Over hundred water supply systems were surveyed to find the underlying causes of failure and poor performance throughout the Amhara Regional State. The results show generally that systems with decision-making power at the community level during design and construction remained working longer than when the decisions were made by a central authority. In addition, the sustainability was better for water systems that were farther away from alternative water resources and contributed more cash and labour. The results of this study of the importance of decision-making at the local level in contrast to the central authority is directly applicable to the introduction of rain water management systems as shown by earlier efforts of installing rain water harvesting systems in the Ethiopian highlands

Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study.

BACKGROUND: Maternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions. METHODS: A cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13-49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*. RESULTS: Of the 6321women included in the study, 714 had a live birth in the 12 months before the survey. One-third of the women (30, 95% CI 26-34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43-51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40-57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37-45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron's I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron's I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women's age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone. CONCLUSIONS: This study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage

Caregivers' and Health Extension Workers' Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study.

INTRODUCTION: Ethiopian Health Extension Workers provide facility-based and outreach services, including home visits to manage sick children, aiming to increase equity in service coverage. Little is known about the scope of the outreach services and caregivers' and health workers' perceptions of these services. We aimed at exploring mothers' and health extension workers' perceptions and experiences of the outreach services provided for the management of childhood illnesses. METHODS: Four focus groups and eight key informant interviews were conducted. A total of 45 community members participated. Interviews were recorded, transcribed verbatim, and translated into English. We applied thematic content analysis, identified challenges in providing outreach services, and suggestions for improvement. We balanced the data collection by selecting half of the participants for interview and focus group discussions from remote areas and the other half from areas closer to the health posts. RESULTS: Mothers reported that health extension workers visited their homes for preventive services but not for managing childhood illnesses. They showed lack of trust in the health workers' ability to treat children at home. The health extension workers reported that they provide sick children treatment during outreach services but also stated that in most cases, mothers visit the health posts when their child is sick. On the other hand, mothers considered distance from home to health post not to be a problem if the quality of services improved. Workload, long distances, and lack of incentives were perceived as demotivating factors for outreach services. The health workers called for support, incentives, and capacity development activities. CONCLUSIONS: Mothers and health extension workers had partly divergent perceptions of whether outreach curative services for children were available. Mothers wanted improvements in the quality of services while health workers requested capacity development and more support for providing effective community-based child health services

Distance, difference in altitude and socioeconomic determinants of utilisation of maternal and child health services in Ethiopia: a geographic and multilevel modelling analysis.

Objective We assessed whether geographic distance and difference in altitude between home to health facility and household socioeconomic status were associated with utilisation of maternal and child health services in rural Ethiopia. Design Household and health facility surveys were conducted from December 2018 to February 2019.SettingForty-six districts in the Ethiopian regions: Amhara, Oromia, Tigray and Southern Nations, Nationalities, and Peoples. Participants A total of 11 877 women aged 13-49 years and 5786 children aged 2-59 months were included.Outcome measuresThe outcomes were four or more antenatal care visits, facility delivery, full child immunisation and utilisation of health services for sick children. A multilevel analysis was carried out with adjustments for potential confounding factors. Results Overall, 39% (95% CI: 35 to 42) women had attended four or more antenatal care visits, and 55% (95% CI: 51 to 58) women delivered at health facilities. One in three (36%, 95% CI: 33 to 39) of children had received full immunisations and 35% (95% CI: 31 to 39) of sick children used health services. A long distance (adjusted OR (AOR)=0.57; 95% CI: 0.34 to 0.96) and larger difference in altitude (AOR=0.34; 95% CI: 0.19 to 0.59) were associated with fewer facility deliveries. Larger difference in altitude was associated with a lower proportion of antenatal care visits (AOR=0.46; 95% CI: 0.29 to 0.74). A higher wealth index was associated with a higher proportion of antenatal care visits (AOR=1.67; 95% CI: 1.02 to 2.75) and health facility deliveries (AOR=2.11; 95% CI: 2.11 to 6.48). There was no association between distance, difference in altitude or wealth index and children being fully immunised or seeking care when they were sick. Conclusion Achieving universal access to maternal and child health services will require not only strategies to increase coverage but also targeted efforts to address the geographic and socioeconomic differentials in care utilisation, especially for maternal health. Trial registration number ISRCTN12040912

Chemotactic and Inflammatory Responses in the Liver and Brain Are Associated with Pathogenesis of Rift Valley Fever Virus Infection in the Mouse

Rift Valley fever virus (RVFV) is a major human and animal pathogen associated with severe disease including hemorrhagic fever or encephalitis. RVFV is endemic to parts of Africa and the Arabian Peninsula, but there is significant concern regarding its introduction into non-endemic regions and the potentially devastating effect to livestock populations with concurrent infections of humans. To date, there is little detailed data directly comparing the host response to infection with wild-type or vaccine strains of RVFV and correlation with viral pathogenesis. Here we characterized clinical and systemic immune responses to infection with wild-type strain ZH501 or IND vaccine strain MP-12 in the C57BL/6 mouse. Animals infected with live-attenuated MP-12 survived productive viral infection with little evidence of clinical disease and minimal cytokine response in evaluated tissues. In contrast, ZH501 infection was lethal, caused depletion of lymphocytes and platelets and elicited a strong, systemic cytokine response which correlated with high virus titers and significant tissue pathology. Lymphopenia and platelet depletion were indicators of disease onset with indications of lymphocyte recovery correlating with increases in G-CSF production. RVFV is hepatotropic and in these studies significant clinical and histological data supported these findings; however, significant evidence of a pro-inflammatory response in the liver was not apparent. Rather, viral infection resulted in a chemokine response indicating infiltration of immunoreactive cells, such as neutrophils, which was supported by histological data. In brains of ZH501 infected mice, a significant chemokine and pro-inflammatory cytokine response was evident, but with little pathology indicating meningoencephalitis. These data suggest that RVFV pathogenesis in mice is associated with a loss of liver function due to liver necrosis and hepatitis yet the long-term course of disease for those that might survive the initial hepatitis is neurologic in nature which is supported by observations of human disease and the BALB/c mouse model