Awareness of people living in Sagure District, Arsi, Ethiopia about ergot fungus (Claviceps purpurea) and ergotism

Ergot is a plant parasitic fungus that belongs to the genus Claviceps, and ergotism is a poisoning caused by secondary metabolites produced mainly by the ergot fungus (Claviceps purpurea). The presence of ergot fungi in the farmers’ field was surveyed, and ergot sclerotia were clearly observed in the farmers’ fields on wild oat plants. A cross-sectional study was therefore conducted in three Kebeles of the Sagure District (Kechema Murkicha, Digelu Kidame and Mankula Negele), near Asela town, Ethiopia, to assess awareness of the residents about ergot fungus and ergotism. From a total of 385 study participants only 100 (26%), knew what ergot and ergotism stand for. Thirty-one percent of the study participants described the most common symptoms of the ergot poisoning as ‘cutting off legs’ and removing wild oats (Avena abyssinica), the host for the ergot fungus, as the main method of prevention of the disease. Among the socio-demographic factors, education level was found to be significantly associated with the knowledge of ergot (p < 0.001), where participants from secondary education and above had better knowledge about ergot fungus and ergotism (cor: 2.5, 95% CI:1.34 – 6.22). From binary logistic regression model fitted, study site has statistically significant association with knowledge about ergot (AOR: 5.34, 95% CI:3.25 – 8.43, p< 0.001). In conclusion, though the fungus was prevalent in the farmers’ fields, majority of the study participants were not aware of ergot fungus and ergotism, thus there is a need to create awareness about the fungus and the disease in order to prevent possible future disease outbreaks

Health seeking behavior of patients diagnosed with cervical cancer in Addis Ababa, Ethiopia

Background: Cervical cancer is increasingly recognized as one of the public health problems among women in developing countries. Most women with cervical cancer are seen in the health care system late with advanced stage of cancer. This study aims to explore the care seeking behavior of women with cervical cancer.Methods: A qualitative study was conducted to explore the health seeking behavior of women with cervical cancer for patients who were admitted with cervical cancer in Tikur Anbessa Hospital. In-depth interviews were conducted with purposively selected participants. Interviews were transcribed verbatim and then translated into English and analyzed using a content analysis approach. The study period was from October 2013 to April 2014.Results: The study found that women diagnosed with cervical cancer lack prior awareness about cervical cancer and availability of screening services. Moreover, decision making to seek medical care up on experiencing early symptoms seems to be delayed. Women reported the first symptom was unusual vaginal bleeding that forces them to seek care. The bleeding could be profound and accompanied by offensive odor. Fear of stigmatization could make women reluctant to seek timely care. Once treatment is started most women found it shockingly expensive.Conclusion: Women lack general awareness about the nature and symptoms of cervical cancer. All health services providers serving women need to sensitize women to seek timely screening services and timely treatment services if cervical cancer is confirmed.Keywords: Cervical Cancer, Health Seeking Behavior, Cervical Screenin

Unusual termination of the right testicular vein

The testicular veins are formed by the veins emerging from the testis and epididymis forming the pampiniform venous plexus. The right testicular vein drains into inferior vena cava and the left testicular vein to the left renal vein. Testicular veins display a great variability with regard to their number, course and sites of termination. Awareness of the possible variations of gonadal vessels is necessary for adequate surgical management.Keywords: Testicular vein, Termination, Inferior vena cava, Renal vei

Clinical ethics dilemmas in a low-income setting - a national survey among physicians in Ethiopia

Background Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. Method A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. Results A total of 587 physicians responded (response rate 91,7%), and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Discussion Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe.publishedVersio

Teachers’ Ethical Professional Practices in Higher Education Institutions: An Instrumental Case Study

The purpose of this study was to explore teachers’ ethical professional practices in the College of Education and Behavioral Sciences in Haramaya University. Instrumental case study design was employed because such design is used when the researcher focuses on one case to understand other similar cases. Fifteen, information-rich study participants were selected purposively. In-depth interviews, FGD, and document analyses were used for collecting data. Data were analyzed thematically. The study revealed that ethical professional practices of teachers are important for upholding respect and prestige in the teaching profession. Despite this, however, the ethical professional practices in the College were deteriorating and deserve attention. The study showed particularly that many unethical professional practices of teachers were exhibited in the college such as lack of transparency in relation to the assessment of students’ achievements, coming late and absence from class, threatening students for the teacher’s own fault, lack of communication with students, and ignoring students’ problems. It is concluded that the status of ethical professional practices in the College deserves close attention. It is recommended that there should be close supervision, professional support, and training on ethical professional practice by the College and other concerned entities of the university

Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers

Background: Though cervical cancer incidence has dramatically decreased in resource rich regions due to the implementation of universal screening programs, it remains one of the most common cancers affecting women worldwide and has one of the highest mortality rates. The vast majority of cervical cancer-related deaths are among women that have never been screened. Prior to implementation of a screening program in Addis Ababa University-affiliated hospitals in Ethiopia, a survey was conducted to assess knowledge of cervical cancer etiology, risk factors, and screening, as well as attitudes and practices regarding cervical cancer screening among women’s health care providers.Methods: Between February and March 2012 an anonymous, self-administered survey to assess knowledge, attitudes, and practices related to cervical cancer and its prevention was distributed to 334 health care providers at three government hospitals in Addis Ababa, Ethiopia and three Family Guidance Association clinics in Awassa, Adama, and Bahir Dar. Data were analyzed using SPSS software and chi-square test was used to test differences in knowledge, attitudes, and practices across provider type.Results: Overall knowledge surrounding cervical cancer was high, although awareness of etiology and risk factors was low among nurses and midwives. Providers had no experience performing cervical cancer screening on a routine basis with \u3c40% having performed any type of cervical cancer screening. Reported barriers to performing screening were lack of training (52%) and resources (53%); however the majority (97%) of providers indicated cervical cancer screening is an essential part of women’s health care.Conclusion: There is a clear need among women’s health care providers for education regarding cervical cancer etiology, risk factors and for training in low-tech, low-cost screening methods. Meeting these needs and improving the infrastructure necessary to implement appropriate screening programs is essential to reduce the burden of cervical cancer in Ethiopia

Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures

Background: Out-of-pocket health expenditures can pose major financial risks, create access-barriers and drive patients and families into poverty. Little is known about physicians’ role in financial protection of patients and families at the bedside in low-income settings and how they perceive their roles and duties when treating patients in a health care system requiring high out-of-pocket costs. Objective: Assess physicians’ concerns regarding financial welfare of patients and their families and analyze physicians’ experiences in reducing catastrophic health expenditures for patients in Ethiopia. Method: A national survey was conducted among physicians at 49 public hospitals in six regions in Ethiopia. Descriptive statistics were used. Results: Totally 587 physicians responded (response rate 91%) and 565 filled the inclusion criteria. Health care costs driving people into financial crisis and poverty were witnessed by 82% of respondants, and 88% reported that costs for the patient are important when deciding to use or not use an intervention. Several strategies to save costs for patients were used: 37–79% of physicians were doing this daily or weekly through limiting prescription of drugs, limiting radiologic studies, ultrasound and lab tests, providing second best treatments, and avoiding admission or initiating early discharge. Overall, 75% of the physicians reported that ongoing and future costs to patients influenced their decisions to a greater extent than concerns for preserving hospital resources. Conclusion: In Ethiopia, a low-income country aiming to move towards universal health coverage, physicians view themselves as both stewards of public resources, patient advocates and financial protectors of patients and their families. Their high concern for family welfare should be acknowledged and the economic and ethical implications of this practice must be further explored.publishedVersio

A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia

Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.publishedVersio

Health gains and fi nancial risk protection aff orded by public fi nancing of selected interventions in Ethiopia: an extended cost-eff ectiveness analysis

Background The way in which a government chooses to fi nance a health intervention can aff ect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public fi nance can insure against catastrophic health expenditures. We aimed to evaluate the health and fi nancial risk protection benefi ts of selected interventions that could be publicly fi nanced by the government of Ethiopia. Methods We used extended cost-eff ectiveness analysis to assess the health gains (deaths averted) and fi nancial risk protection aff orded (cases of poverty averted) by a bundle of nine (among many other) interventions that the Government of Ethiopia aims to make universally available. These nine interventions were measles vaccination, rotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumonia treatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment. Findings Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the most deaths are measles vaccination (367 deaths averted per $100 000 spent), pneumococcal conjugate vaccination (170 deaths averted per$100 000 spent), and caesarean section surgery (141 deaths averted per $100 000 spent). The interventions that avert the most cases of poverty are caesarean section surgery (98 cases averted per$100 000 spent), tuberculosis treatment (96 cases averted per $100 000 spent), and hypertension treatment (84 cases averted per$100 000 spent). Interpretation Our approach incorporates fi nancial risk protection into the economic evaluation of health interventions and therefore provides information about the effi ciency of attainment of both major objectives of a health system: improved health and fi nancial risk protection. One intervention might rank higher on one or both metrics than another, which shows how intervention choice—the selection of a pathway to universal health coverage—might involve weighing up of sometimes competing objectives. This understanding can help policy makers to select interventions to target specifi c policy goals (ie, improved health or fi nancial risk protection). It is especially relevant for the design and sequencing of universal health coverage to meet the needs of poor populations

How are smallholder households coping with and adapting to climate-related shocks in Doyogena climate-smart landscapes, Ethiopia?

This synthesis presents an analysis of the results from the 2019 monitoring implemented as a contribution to Activity 1.2 Assessment of climate-smart agricultural options in the Doyogena Climate-Smart Village (CSV), in the context of the CCAFS-EU-IFAD grant reference 2000002575 for the research project “Building livelihoods and resilience to climate change in East & West Africa: Agricultural Research for Development (AR4D) for large-scale implementation of Climate-Smart Agriculture” led by the Alliance of Bioversity International and CIAT