Status of Schistosoma mansoni prevalence and intensity of infection in geographically apart endemic localities of Ethiopia: A comparison

BACKGROUND: Schistosomiasis is one of the chronic and neglected tropical diseases affecting rural communities. Heavy infections contribute to anemia and can retard children's growth, physical activity and cognitive function. This study was conducted in order to determine the prevalence, intensity and variation of Schistosoma mansoni infection among human subjects in geographically apart localities. The prevalence and intensity of Schistosoma mansoni infection was assessed in three geographically apart endemic areas of Ethiopia from May to August 2010 through cross-sectional approach.METHODS: A total of 1073 individuals (528 males and 545 females) were found eligible for the study. Their age ranged from 5-60 years with mean age of 11 years in Wondo Genet, 22 years in Kemissie and 24 years in Sille-Elgo. Small plastic sheets were distributed to the study participants and sizable stool specimens were collected and examined using Kato-Katz method (41.7mg template).RESULT: The prevalence of Schistosoma mansoni infection among the study participants in Kemissie, Wondo Genet and Sille-Elgo was 89.6%, 59.9%, and 31.6%, respectively. The highest geometric mean of egg per gram of stool for Kemissie, Wondo Genet and Sille-Elgo was, 5208 and 346, 8472 and 252, 3960 and 91, respectively.CONCLUSION: It was observed that there was comparable variation in the prevalence and intensity of infection among the study localities. Moreover, it is indicated that S. mansoni is still an ongoing public health problem which requires integrated intervention activities in the country.KEYWORDS: Schistosoma mansoni; intensity of infection; geographic variation; Ethiopi

Community knowledge, attitude and practice on rabies, incidence in humans and animals and risk factors to rabies in selected districts of Tigray Region, Ethiopia

Community awareness and assessing the trend of suspected rabies cases play a significant role in preventing its fatality. Therefore, a cross-sectional study design was employed (October 2016 - April 2017) to assess community knowledge, attitude and practice (KAP), and Incidence and risk factors to rabies (human and animal) in the study area. A semi-structured questionnaire was employed to collect required information from 1440 study participants. Retrospective data of five-year (2012-2016) from hospitals and health centers (human cases), and veterinary clinics (animal cases) was used. Majority of the study participants (64.3%) were rural residents, 95.2% have heard about rabies and 50.1% were found dog owners. Among the study participants, 72.2%, 66.0%, and 62.4% have a good level of knowledge, attitude, and practices about rabies, respectively. A strong association between knowledge, attitude and practice with sex; educational level; occupation, dog ownership and rural/urban dwellers (p<0.05) was recorded. Furthermore, a total dog bite cases of 398 domestic animals and 4617 humans were found registered on casebooks of both veterinary and human health service centers of the study districts during the five years study period among which the highest percentage (36.4%) was recorded from canines. The highest anti-rabies vaccine coverage recorded was 36.0% in the year 2016, and higher human dog bite cases recorded was 50.1% on individuals aged between 5-15 years (both male and female). Hence, the current findings suggest that there is a need for coordinated and integrated effort of government, professionals (medical and veterinarians), community and other stake holders towards rabies control and prevention.Keywords: Animal, Human, Tigray, Rabies, Statu

Schistosoma mansoni Infection in Finchaa Sugar Estate: Public health Problem Assessment based on Clinical Records and Parasitological Surveys, Western Ethiopia

The survey of Schistosoma mansoni (S. mansoni) in Finchaa Sugar Estate, Western Ethiopia, was conducted to investigate the prevalence and health problems of schistosomiasis with some of the risk factors. The examination was undertaken based on the analysis of retrospective clinical data from the health center and a cross-sectional parasitological examinations using Kato-thick smear slides in April-June 2012/2013. Over the period 2008 to 2013 average prevalence among suspected patients at the health centre was 30.9%. Examination of double kato-thick smear slides from a random sample of 602 individuals from most schistosomiasis affected camp 7 revealed the prevalence of 37.5%. S. mansoni infection is become a year-round public health problem in Finchaa, Sugar Estate possibly due to permanent streams, water bodies and water contact behaviors and also reduced effectiveness of current control measures. Among the 7th camps, village A (camp 7) is the most schistosomiasis affected area (37.5%) followed by Kuyisa (25%). This is attributed to the presence of permanent stream (Fekerie stream) near camp 7. The present finding shows that the prevalence and intensity of schistosomiasis in the more affected camp 7 of Finchaa Sugar Estate was significantly higher among males than in females and its prevalence and intensity was found to be higher among study population within the age group of 11-20 years old. This study indicates that schistosomiasis is a major health problem in Finchaa Sugar Estate with moderate prevalence. The study results will provide an additional clinical and parasitological data on the current status of S. mansoni in Finchaa Sugar Estate and could serve as a guide in designing, developing and implementing intervention strategies to mitigate morbidity due to S. mansoni especially in highly risk groups under the Ethiopian health service system.Keywords: Egg per gram; Finchaa Sugar Estate; Kato-katz; Schistosomiasis; S. mansoni; Public healt

Weight gain after smoking cessation and risk of major chronic diseases and mortality

Importance: Smoking cessation is frequently followed by weight gain; however, whether weight gain after quitting reduces the health benefits of quitting is unclear. Objective: To examine the association between weight change after smoking cessation and the risk of cardiovascular diseases (CVD), type 2 diabetes, cancer, chronic obstructive pulmonary disease (COPD), and all-cause mortality. Design, Setting, and Participants: This cohort study analyzed data from a nationally representative sample of Australian adults aged 18 years or older who were studied between 2006 and 2014. Smoking status and anthropometric measurements were self-reported annually. Cox proportional hazards regressions were used to determine the hazard ratios (HRs) for the association between changes in weight and body mass index (BMI) and the risk of CVD, type 2 diabetes, cancer, COPD, and mortality. Data were analyzed in January 2019. Exposures: Annual self-reported smoking status; years since quitting. Main Outcomes and Measures: Weight gain after quitting, incident CVD, type 2 diabetes, cancer, COPD, and all-cause mortality. Results: Of a total 16663 participants (8082 men and 8581 women; mean [SD] age, 43.7 [16.3] years), those who quit smoking had greater increases in weight (mean difference [MD], 3.14 kg; 95% CI, 1.39-4.87) and BMI (MD, 0.82; 95% CI, 0.21-1.44) than continuing smokers. Compared with continuing smokers, the HRs for death were 0.50 (95% CI, 0.36-0.68) among quitters who lost weight, 0.79 (95% CI, 0.51-0.98) among quitters without weight change, 0.33 (95% CI, 0.21-0.51) among quitters who gained 0.1 to 5.0 kg, 0.24 (95% CI, 0.11-0.53) among quitters who gained 5.1 to 10 kg, and 0.36 (95% CI, 0.16-0.82) among quitters who gained more than 10 kg. The HRs for death were 0.61 (95% CI, 0.45-0.83) among quitters who lost BMI, 0.86 (95% CI, 0.51-1.44) among quitters without change in BMI, 0.32 (95% CI, 0.21-0.50) among quitters who gained up to 2 in BMI, and 0.26 (95% CI, 0.16-0.45) among quitters who gained more than 2 in BMI. Conclusions and Relevance: This cohort study found that smoking cessation was accompanied by a substantial weight gain; however, this was not associated with an increased risk of chronic diseases or an attenuation of the mortality benefit of cessation

Hypertension treatment practices and its determinants among ambulatory patients:Retrospective cohort study in Ethiopia

Objectives We examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP).Design A retrospective cohort study in six public hospitals, Ethiopia.Participants Adult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital.Outcome Controlled BP (&lt;140/90 mm Hg) and treatment intensification of patients with uncontrolled BP.Results The study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant-positive-determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09).Conclusions The level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.</p

Governments' policy response to drought in Eswatini and Lesotho : a systematic review of the characteristics, comprehensiveness, and quality of existing policies to improve community resilience to drought hazards

The southern African kingdoms of Eswatini and Lesotho experience recurrent drought-induced disasters. Policies have been enacted, but no attempt has been made to synthesise the effects on disaster resilience. This review analyses the characteristics, quality, and comprehensiveness of drought-resilience policies in Eswatini and Lesotho. We have systematically reviewed public policies that shape responses to disaster resilience published between 1 January 1980 and 30 June 2019. A combination of keywords was used to search electronic bibliographic databases, multidisciplinary databases, key organisational websites, and the first 20 pages of Google for policies that addressed disaster and/or drought resilience. Identified documents were downloaded into an EndNote database and screened for eligibility using predetermined criteria. The logic of events framework was used for quality assessment, and a metaethnographic approach was applied for data synthesis. Three broad categories of characteristics, thematic outcomes and quality, and comprehensiveness of policy documents emerged and are presented. Policy responses contributing to disaster resilience were found in n = 32 out of 13,700 documents. Three (n = 3/32) policies were statutory, and the rest were nonstatutory. Eleven (n = 11/32) were assessed to be of high quality. Policy responses relating to drought resilience focused on reducing vulnerability to recurrent disasters; promoting drought and climate change adaptation; improving agriculture and food security; safeguarding cultural heritage; and preventing gender inequality and gender-based violence as well as improving disaster governance. However, the construct of drought resilience was not strongly articulated as a major policy goal across policy documents. There is an urgent need to promote better understanding of drought resilience in order to motivate policymakers to steer away from reactive interventions and position resilience as a major national policy goal in both countries to expedite inclusive growth and safeguard development gains and the health and wellbeing of the majority of their populations who are rural-based populations

Return of chloroquine-sensitive Plasmodium falciparum parasites and emergence of chloroquine-resistant Plasmodium vivax in Ethiopia

BACKGROUND: Increased resistance by Plasmodium falciparum parasites led to the withdrawal of the antimalarial drugs chloroquine and sulphadoxine-pyrimethamine in Ethiopia. Since 2004 artemether-lumefantrine has served to treat uncomplicated P. falciparum malaria. However, increasing reports on delayed parasite clearance to artemisinin opens up a new challenge in anti-malarial therapy. With the complete withdrawal of CQ for the treatment of Plasmodium falciparum malaria, this study assessed the evolution of CQ resistance by investigating the prevalence of mutant alleles in the pfmdr1 and pfcrt genes in P. falciparum and pvmdr1 gene in Plasmodium vivax in Southern and Eastern Ethiopia. METHODS: Of the 1,416 febrile patients attending primary health facilities in Southern Ethiopia, 329 febrile patients positive for P. falciparum or P. vivax were recruited. Similarly of the 1,304 febrile patients from Eastern Ethiopia, 81 febrile patients positive for P. falciparum or P. vivax were included in the study. Of the 410 finger prick blood samples collected from malaria patients, we used direct sequencing to investigate the prevalence of mutations in pfcrt and pfmdr1. This included determining the gene copy number in pfmdr1 in 195 P. falciparum clinical isolates, and mutations in the pvmdr1 locus in 215 P. vivax clinical isolates. RESULTS: The pfcrt K76 CQ-sensitive allele was observed in 84.1% of the investigated P.falciparum clinical isolates. The pfcrt double mutations (K76T and C72S) were observed less than 3%. The pfcrt SVMNT haplotype was also found to be present in clinical isolates from Ethiopia. The pfcrt CVMNK-sensitive haplotypes were frequently observed (95.9%). The pfmdr1 mutation N86Y was observed only in 14.9% compared to 85.1% of the clinical isolates that carried sensitive alleles. Also, the sensitive pfmdr1 Y184 allele was more common, in 94.9% of clinical isolates. None of the investigated P. falciparum clinical isolates carried S1034C, N1042D and D1246Y pfmdr1 polymorphisms. All investigated P. falciparum clinical isolates from Southern and Eastern Ethiopia carried only a single copy of the mutant pfmdr1 gene. CONCLUSION: The study reports for the first time the return of chloroquine sensitive P. falciparum in Ethiopia. These findings support the rationale for the use of CQ-based combination drugs as a possible future alternative

Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries : a systematic review and meta-analyses

The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I 2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI-0.32% to-0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide