Effectiveness of interventions to prevent mother-to-child transmission of HIV in Southern Ethiopia

Behailu Merdekios1, Adebola A Adedimeji2 1College of Medicine and Health Sciences, Arba Minch University, Ethiopia; 2Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, New York, USA Background: In Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT) of human immunodeficiency virus (HIV) is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women. Methods: A multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained. Results: Of the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1%) had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001) and voluntary counseling and testing for pregnant women (P < 0.05). Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination. Conclusion: In the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels. Keywords: human immunodeficiency virus, mother-to-child transmission, pregnant women, Ethiopi

Association of Men's Awareness of Danger Sign of Obstetric Complication and Male Involvement’s in Birth Preparedness Practices at South Ethiopia

The Ethiopian Demographic and Health Survey (EDHS) indicate that maternal mortality in Ethiopia is one of the highest in the world. This death toll can be prevented partially through increasing awareness on danger sign of obstetric complications and birth preparedness practices for mother, husbands and other family members. Community based cross sectional study was done. Adult males with a wife or partner who had been through childbirth in the preceding 36 months were included in the study. Data was collected by pretested structured questionnaires and multi stage cluster sampling was used to reach 845 samples which were calculated by using StatCalc program of Epi Info 7. Collected data was cleaned and entered in to Epi Info 7 and exported to SPSS (IBM-20) for further analysis. Hierarchical logistic regression model and adjusted odds ratio with 95% confident interval were used to show association between men awareness and birth preparedness practices. The total numbers of men interviewed were 836 that makes response rate of 98.9%. Severe abdominal pain (87%) was the most recognized danger sign during pregnancy and 17.9% men involve in saving money.  Forty two point two percent of men had awareness of danger sign and 9.4 %( 95% CI: (7.42, 11.4) of men involved in birth preparedness practice. Strong association between men awareness of danger sign of obstetric complications and involvements in birth preparedness practices persisted after adjusting for probable confounders. Thus respondents who had awareness of danger signs were two times (AOR: 1.91, 95% CI: 1.06, 3.41) more likely to involve in preparedness practice than respondents who had no awareness of danger signs of obstetric complication. The prevalence of men awareness of danger sign & involvement in birth preparedness practice was very low

MARZANO'S INSTRUCTIONAL STRATEGIES: FOSTERING INFORMATION ANALYSIS AND PROCESSING SKILLS OF PLANT ANATOMY IN TEACHER EDUCATION

AbstractThis study proposes a design for a Plant Anatomy course by adapting Marzano's instructional framework to develop students’ information analysis and processing skills. The focus of the Plant Anatomy course is determined because it requires complex cognitive processing to integrate knowledge about plant tissue structure with changes in plant structure based on adaptation strategies in their habitat. This study employs a quantitative method, utilising information analysis ability tests and process skills tests as its instruments. The data were analysed descriptively using an assessment rubric. The design is then tested on 106 undergraduate students in Biology Education taking the Plant Anatomy course during data collection at a university in West Java, Indonesia. The results showed that the Marzano-based plant anatomy course design could facilitate students' information analysis and processing skills due to a conducive learning environment, the utilisation of prior knowledge, the development of thinking potential, the delivery of meaningful information, contextual learning, and cooperative learning. This study further proposes using this design when studying materials with a high concept interconnection.

Expanded program of immunization coverage and associated factors among children age 12 – 23 months in Arba Minch town and Zuria District, Southern Ethiopia, 2013

BACKGROUND: Immunization averts an estimated 2 to 3 million deaths every year globally. In Ethiopia only quarter of children are fully immunized; the rest are remained at risk for vaccine-preventable mortality. To increase the immunization, its coverage and predictors has to be identified. This study has measured immunization coverage and identified the predictors. METHODS: Cross-sectional community based study has been conducted within 630 age 12–23 months children in 15 districts of Arba Minch town and Arba Minch Zuria district, Southern Ethiopia in March 2013. Census was done to identify eligible children. The 2005 world health organization expanded program of immunization cluster sampling method has been used. Data were collected using semi-structured pretested Amharic version questionnaire by interviewing index children’s mothers/caretakers, copying from vaccine card and observing BCG vaccine scar. Data were processed using SPSS version 16. Associations between dependent and independent variables has been assessed and presented using three consecutive logistic regression models. RESULT: Nearly three fourth (73.2%) of children in Arba Minch Town and Arba Minch Zuria district were fully immunized. The rest 20.3% were partially immunized and 6.5% received no vaccine. Mother education, mothers’ perception to accessibility of vaccines, mothers’ knowledge to vaccine schedule of their site, place of delivery and living altitude were independent predictors of children immunization status. CONCLUSION: Expanded program of immunization (EPI) coverage at Arba Minch town and Arba Minch Zuria district is better than the national immunization coverage but still below the goal. Educating mother, promoting institution delivery could help to maintain and enhance current immunization coverage. More emphasis should be given to the highland areas of the area

High-resolution habitat suitability model for Phlebotomus pedifer, the vector of cutaneous leishmaniasis in southwestern Ethiopia

Background Phlebotomus pedifer is the vector for Leishmania aethiopica causing cutaneous leishmaniasis (CL) in southwestern Ethiopia. Previous research on the transmission dynamics of CL resulted in recommendations for vector control. In order to target these interventions towards affected areas, a comprehensive understanding of the spatial distribution of P. pedifer at high spatial resolution is required. Therefore, this study determined the environmental predictors that facilitate the distribution of P. pedifer and created a map indicating the areas where conditions are suitable for survival of the vector in southwestern Ethiopia with high spatial resolution. Methods Phlebotomus pedifer presence points were collected during two entomological surveys. Climate, vegetation and topographic variables were assembled. Climate variables were interpolated with variables derived from high-resolution digital elevation models to generate topoclimatic layers representing the climate conditions in the highlands. A Maximum Entropy model was run with the presence points, predicting variables and background points, which were selected based on a bias file. Results Phlebotomus pedifer was the only captured Phlebotomus species in the study area and was collected at altitudes ranging between 1685 and 2892 m. Model projections indicated areas with suitable conditions in a ‘belt’ surrounding the high mountain peaks. Model performance was high, with train and test AUC values being 0.93 and 0.90, respectively. A multivariate environmental similarity surface (MESS) analysis showed that the model projection was only slightly extrapolated for some of the variables. The mean annual temperature was the environmental variable, which contributed most to the model predictions (60.0%) followed by the seasonality in rainfall (13.2%). Variables representing steep slopes showed very low importance to model predictions. Conclusions Our findings indicate that the suitable habitats for P. pedifer correspond well with the altitudes at which CL was reported previously, but the predictions are more widely distributed, in contrast with the description of CL to occur in particular foci. Moreover, we confirm that vector distribution is driven by climate factors, suggesting inclusion of topoclimate in sand fly distribution models. Overall, our model provides a map with a high spatial resolution that can be used to target sand fly control measures in southwestern Ethiopia.publishedVersio

Feeding behavior and activity of Phlebotomus pedifer and potential reservoir hosts of Leishmania aethiopica in southwestern Ethiopia

Background Cutaneous leishmaniasis (CL) is a major public health concern in Ethiopia. However, knowledge about the complex zoonotic transmission cycle is limited, hampering implementation of control strategies. We explored the feeding behavior and activity of the vector (Phlebotomus pedifer) and studied the role of livestock in CL transmission in southwestern Ethiopia. Methods Blood meal origins of engorged sand flies were determined by sequencing host DNA. A host choice experiment was performed to assess the feeding preference of P. pedifer when humans and hyraxes are equally accessible. Ear and nose biopsies from livestock were screened for the presence of Leishmania parasites. Sand flies were captured indoor and outdoor with human landing catches and CDC light traps to determine at which time and where P. pedifer is mostly active. Principal findings A total of 180 P. pedifer sand flies were found to bite hosts of 12 genera. Humans were the predominant blood meal source indoors (65.9%, p < 0.001), while no significant differences were determined outdoors and in caves. In caves, hyraxes were represented in blood meals equally as humans (45.5% and 42.4%, respectively), but the host choice experiment revealed that sand flies have a significant preference for feeding on hyraxes (p = 0.009). Only a single goat nose biopsy from 412 animal samples was found with Leishmania RNA. We found that P. pedifer is predominantly endophagic (p = 0.003), but occurs both indoors and outdoors. A substantial number of sand flies was active in the early evening, which increased over time reaching its maximum around midnight. Conclusion In contrast to earlier suggestions of exclusive zoonotic Leishmania transmission, we propose that there is also human-to-human transmission of CL in southwestern Ethiopia. Livestock does not play a role in CL transmission and combined indoor and outdoor vector control measures at night are required for efficient vector control.publishedVersio

Challenges and Strategies for Mainstreaming Neglected Tropical Diseases Campaign Interventions in Ethiopia.

Mainstreaming neglected tropical diseases (NTDs) interventions in national health systems is one of the key strategies emphasized in the WHO Roadmap for NTDs. However, there is limited evidence on implementing the proposed mainstreaming approaches effectively. We used a participatory ranking methodology in Ethiopia, using consultative workshops with purposively selected stakeholders, including NTDs program leaders from the government and partners, primary health care (PHC) workers, and community leaders and volunteers. Our aim was to identify, rank, and contextualize mainstreaming challenges and strategies, which were then synthesized using the Primary Health Care Performance Initiative framework. Thirty-three stakeholders at the national, regional, district, PHC, and community levels participated in two consultative workshops conducted in the Adama and Shashemene towns in Ethiopia. The stakeholders identified 73 mainstreaming challenges related to service delivery (32 [43.8%]), inputs (22 [30.1%]), systems (18 [24.7%]), and outputs (1 [1.4%]). The top three most frequently cited and ranked challenges were poor data recording and reporting, poor drug management and logistics, and weak supportive supervision and monitoring. Among the 185 strategies identified to address these challenges, the three most frequently cited were establishing a strong, supportive supervision and monitoring system, continuous on-the-job training to build workforce competence, and performance-based motivation. Multifaceted NTDs campaign intervention mainstreaming challenges that are deep-rooted in the health system were identified. The suggested strategies to address them should be given due consideration not only to guide future mainstreaming efforts but also to facilitate health system strengthening

In vitro Antibacterial Activity and Phytochemical Analysis of Nicotiana tabacum L. Extracted in Different Organic Solvents

Background: Controlling infectious disease using medicinal plants is the oldest healthcare known to mankind. Regardless of the enormous advances observed in modern medicine, medicinal plants are still playing vital roles. However, only a small proportion of medicinal plants are examined for bioactive compounds which may vary in different factors. This study aimed to evaluate phytochemical constituent and antimicrobial activities of Nicotiana tabacum L. extracted by different solvents against three set of bacteria. Methods: Nicotiana tabacum L. was collected from the Western Ethiopia and extracted in seven organic solvents. An in-vitro anti-bacterial activity of plant extracts was carried out by agar well diffusion assay against microbial type culture collection of human pathogens, clinical bacterial isolates, and biofilm forming bacteria. Gas Chromatographic and Mass Spectroscopic (GC-MS) analysis was used to determine the phytochemical constituents. Results: Antimicrobial activities of plant extract vary by extraction solvents; and ethyl acetate based extracts showed better antimicrobial activities. Of the experimental organisms, biofilm forming uropathogens were the most sensitive while clinical isolates were quite resistant. Analysis of the active ethyl acetate extract by GC-MS evinced a mixture of five volatile compounds; and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S) was the major compound detected. The overall results of the present study revealed that N. tabacum L extract has high antimicrobial activities against biofilm forming uropathogens. Conclusion: High antimicrobial activity was observed in ethyl acetate extract of N. tabacum against the biofilm forming bacteria whereas the clinically isolated bacteria were the most resistant group. The antibacterial property demonstrated could be due to Pyridine, 3-(1-methyl-2-pyrrolidinyl)-(S) with a broad spectrum of activity. </jats:sec