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

Crop vs. tree : Can agronomic management reduce trade-offs in tree-crop interactions?

Scattered trees dominate smallholder agricultural landscapes in Ethiopia, as in large parts of sub-Saharan Africa (SSA). While the inclusion of scattered trees could provide a viable pathway for sustainable intensification of these farming systems, they also lead to trade-offs. We carried out a study to: 1) explore the rationale of farmers to maintain on-farm trees beyond crop yield; 2) quantify the impact of agronomic practices on the outcome of tree-crop interactions; and 3) analyse partial economic trade-offs for selected on-farm tree species at farm scale. We recorded agronomic practices within the fields of 135 randomly selected farms from seedbed preparation to harvesting. A multivariate analysis showed that farmers maintained on-farm trees because of their direct timber, fencing, fuelwood, and charcoal production values. Trees generally had a significant negative effect on maize yield. Mean grain yields of 1683, 1994 and 1752 kg ha−1 under the canopies of Cordia, Croton and Acacia, respectively, were significantly lower than in their paired open field with mean yields of 4063, 3415 and 2418 kg ha−1. Besides, more income from trees was accompanied by less income from maize, highlighting trade-offs. However, agronomic practices such as early planting, variety used, improved weed management, fine seedbed preparation and higher rates of nitrogen fertilizer significantly reduced yield penalties associated with trees. We found an inverse relationship between land size and on-farm tree density, implying that the importance of trees increases for land-constrained farms. Given the expected decline in per capita land size, scattered trees will likely remain an integral part of these systems. Thus, utilizing ‘good agronomic practices’ will be vital to minimize tree-crop trade-offs in the future

Major vectors and vector-borne diseases in small ruminants in Ethiopia: A systematic review

Vector-borne diseases are among major health constraints of small ruminant in Ethiopia. While various studies on single vector-borne diseases or presence of vectors have been conducted, no summarized evidence is available on the occurrence of these diseases and the related vectors. This systematic literature review provides a comprehensive summary on major vectors and vector-borne diseases in small ruminants in Ethiopia. Search for published and unpublished literature was conducted between 8th of January and 25th of June 2015. The search was both manual and electronic based. The databases used in electronic search were PubMed, Web of Science, CAB Direct and AJOL. For most of the vector-borne diseases, the summary was limited to narrative synthesis due to lack of sufficient data. Meta-analysis was computed for trypanosomosis and dermatophilosis while, meta-regression and sensitivity analysis was done only for trypanososmosis due to lack of sufficient report on dermatophilosis. Owing emphasis to their vector role, ticks and flies were summarized narratively at genera/species level. In line with, 43 peer-reviewed articles passed the inclusion criteria out of 106 initially identified research reports. Data on 7 vector-borne diseases were extracted at species and region level from each source. Accordingly, the pooled prevalence estimate of trypanosomosis was 3.7% with 95% confidence interval (CI) 2.8, 4.9), while that of dermatophilosis was 3.1% (95% CI: 1.6, 6.0). The in-between study variance noted for trypanosomosis was statistically significant (p < 0.05). Among the three covariates considered for meta-regression, only one (species) fitted the final model significantly (p < 0.05) and explained 65.44% of the between studies variance (R2). The prevalence in sheep (5.5%) increased nearly by 34% compared to goats (2.9%). The parasitic presence in blood was documented for babesiosis (3.7% in goats); and anaplasmosis (3.9% in sheep). Serological evidence was retrieved for bluetongue ranging from 34.1% to 46.67% in sheep, and coxiellosis was 10.4% in goats. There was also molecular evidence on the presence of theileriosis in sheep (93%, n = 160) and goats (1.9%, n = 265). Regarding vectors of veterinary importance, 14 species of ticks in five genera, four species of Glossina and 4 genera of biting flies were reported. Despite the evidence on presence of various vectors including ticks, flies, mosquitoes and midges, research report on vector-borne diseases in Ethiopia are surprisingly rare. Especially considering the ongoing climate change, which is likely to affect distribution of vectors, better evidence on the current situation is urgently needed in order to prevent spread or to model future distribution scenarios

A meta-analysis of contagious caprine pleuropneumonia (CCPP) in Ethiopia

This systematic literature review was initiated due to lack of comprehensive information on the status and distribution of contagious caprine pleuropneumonia (CCPP) in Ethiopia. The objectives of the review were thus to provide a pooled prevalence estimate of CCPP in the country and asses the level of in between study variance among the available reports. To this end manual and electronic search was conducted between 8th of January and 25th of June 2015. A total of twelve published articles and one MSc thesis was retrieved from19 initially identified studies. Twenty five animal level datasets were extracted at regional level considering some hypothesized predictors. The retrieved data were summarized in a meta-analytical approach. Accordingly, the pooled prevalence estimate of CCPP was 25.7% (95% CI:20.9,31.0).The inverse variance square (I2) that explains the variation in effect size attributed to reports true heterogeneity was 95.7%.The sub-group analysis was also computed for assumed predictors including, age, sex, type of study population, production systems and regional states. Among these predictors, study population type revealed statistically significant difference (P < 0.05). Accordingly, the prevalence estimate for samples collected at abattoir was 39.2%, while that of samples collected at field level was 22.4%. In the final model, type of study population fitted the multivariable meta-regression model accounting for 22.87% of the explainable proportion of heterogeneity among the presumed predictors. Evidence on isolation and confirmation of Mycoplasma capricolum sub spp capripneumonie in the country was obtained from five regional states. In conclusion, it is recommended to further investigate facilities related with transportation and collection premises along with potential role of sheep in the epidemiology of CCPP. Finally, the review emphasizes the need for monitoring the ongoing CCPP control intervention and introduces amendments based on the findings. Besides more surveys are needed in some of the regions where no or few valid data was available

Impact of safe water programs on water treatment practices of people living with human immunodeficiency virus, Ethiopia, 2008

Household water chlorination has been shown to reduce diarrhea incidence among people living with Human Immunodeficiency Virus (PLHIV). Some HIV programs in Ethiopia previously provided a socially marketed chlorination product (brand name WuhaAgar) to prevent diarrhea. To evaluate the program, we compared WuhaAgar use and water treatment practices between 795 clients from 20 antiretroviral therapy (ART) clinics and 795 community members matched by age, sex, and neighborhood. Overall, 19% of study participants reported water treatment with WuhaAgar. Being an ART clinic client was associated with reported treatment of drinking water (matched odds ratios (mOR): 3.8, 95% confidence interval (CI): 2.9&ndash;5.0), reported current water treatment with WuhaAgar (mOR: 5.5, 95% CI 3.9&ndash;7.7), and bottles of WuhaAgar observed in the home (mOR: 8.8, 95% CI 5.4&ndash;14.3). Being an ART clinic client was also associated with reported diarrhea among respondents (mOR: 4.8, 95% CI 2.9&ndash;7.9) and household members (mOR:2.8, 95% CI: 1.9&ndash;4.2) in the two weeks preceding the survey. Results suggest that promoting and distributing water chlorination products in ART clinics was effective in increasing access to and use of water treatment products among PLHIV. The positive association between ART clinic attendees and diarrhea likely resulted from the immunocompromised status of ART clinic clients

Impact of an Educational Clinical Video Combined with Standard Helping Babies Breathe Training on Acquisition and Retention of Knowledge and Skills among Ethiopian Midwives

Helping Babies Breathe (HBB) is an evidence-based neonatal resuscitation program designed for implementation in low-resource settings. While HBB reduces rates of early neonatal mortality and stillbirth, maintenance of knowledge and skills remains a challenge. The extent to which the inclusion of educational clinical videos impacts learners’ knowledge and skills acquisition, and retention is largely unknown. We conducted a cluster-randomized controlled trial at two public teaching hospitals in Addis Ababa, Ethiopia. We randomized small training group clusters of 84 midwives to standard HBB vs. standard HBB training supplemented with exposure to an educational clinical video on newborn resuscitation. Midwives were followed over a 7-month time period and assessed on their knowledge and skills using standard HBB tools. When comparing the intervention to the control group, there was no difference in outcomes across all assessments, indicating that the addition of the video did not influence skill retention. Pass rates for both the control and intervention group on bag and mask skills remained low at 7 months despite frequent assessments. There is more to learn about the use of educational videos along with low-dose, high-frequency training and how it relates to retention of knowledge and skills in learners

Improved health among people living with HIV/AIDS who received packages of proven preventive health interventions, Amhara, Ethiopia.

In 2009, basic care packages (BCP) containing health products were distributed to HIV-infected persons in Ethiopia who were clients of antiretroviral therapy clinics. To measure health impact, we enrolled clients from an intervention hospital and comparison hospital, and then conducted a baseline survey, and 7 bi-weekly home visits. We enrolled 405 intervention group clients and 344 comparison clients. Intervention clients were more likely than comparison clients to have detectable chlorine in stored water (40% vs. 1%, p<0.001), soap (51% vs. 36%, p<0.001), and a BCP water container (65% vs. 0%, p<0.001) at every home visit. Intervention clients were less likely than comparison clients to report illness (44% vs. 67%, p<0.001) or health facility visits for illness (74% vs. 95%, p<0.001), and had lower median illness scores (1.0 vs. 3.0, p<0.05). Participation in the BCP program appeared to improve reported health outcomes