Uptake and barriers of voluntary counseling and testing among antenatal care attendants, southwest Ethiopia

BACKGROUND . Voluntary counseling and testing (VCT) service provides an essential knowledge, skill and helps pregnant women to access intervention such as short course antiretroviral and infant feeding options. Therefore, the potential barriers to the service need to be assessed. OBJECTIVE: This study is intended to examine the uptake of VCT and its barrier among Antenatal care (ANC) attendants in southwest Ethiopia. METHODS- Health institution based cross-sectional study was conducted from Sept. 1. 2004 to Nov. 1, 2004 a mong ANC attendants in southwest Ethiopia. A total of 285 pregnant women were selected conveniently. Additionally, five experienced counselors were involved in the study. Both qualitative and quantitative interviews methods were utilized using structured questionnaires. RESULT-Out of a total of 285 pregnant women who participated in the study, 77(27% had decepted VCT. The acceptance rate was higher among 16-20 years old women (p<0.05) and those from urban résidences (p<0.025). Women who are single, divorced or widowed were also found to have more acceptance of VCT than married women (P<0.001). Among tested women 61(79.2%) received test result. Qualitative analysis showed that I ack of decision-making a utonomy and fear of partner's reactions were identified as major barriers. The reason for low return for test result was the women do not want to know their HIV status; but gave their blood to avoid offending the counselors. CONCLUSION - This study revealed that the uptake of VCT service is very low. Therefore, to increase the utilization of VCT service at ANC setting, problems associated with the service should be addressed. This includes quality of counseling, provision of test result on same day and addressing individual concerns

Management of undescended testes: a retrospective study from a tertiary hospital in Ethiopia

Background: Undescended testis is one of the commonest congenital malformations seen in boys. The aim of this study is to evaluate the pattern of presentation, approach to diagnosis, treatment and follow up in Tikur Anbesa Specialized Hospital, a tertiary teaching hospital in Ethiopia.Methods: This is a retrospective cross sectional study of all boys with undescended testis operated in Tikur Anbesa Specialized Hospital between September 2012 and August 2014.Results: Of 82 boys operated within the study period, 66 boys with 78 undescended testes are studied. Twenty-six percent (17/66)came before the age of 2 years, while the majority of the study group, 50% (33/66), presented beyond 5 years of age. Of the 17 boys brought to the hospital before 2 years, only 41% (7/17) them were treated before the age of two years. The majority 89% (59/66) of the boys were treated after 2 years of age. Seventy-one testes of 78 [91%] were in the inguinal canal, 5 were intra-abdominal and 2 were absent. 46% (36/78) were on the left side, 29% (23/78) on the right side and the rest were bilateral. Among the 54 boys who had ultrasound examination, the ultrasound report is consistent with operative findings in 33 [61%]. Associated congenital malformations were found in 31.8% (21/66) of the boys. Hypospadia was the predominant malformation comprising 38% (8/21) of the total congenital malformations. Orchidopexy was done for 82% (64/78) of the total testes, orchiectomy was done for 9% (7/78) and biopsy was taken in 1 case. Among the total operated boys only 62% (41/66) were followed in our clinic; of those who had follow up 10% (4/41) testes atrophied and 1 [2%] testis retracted.Conclusion: Boys with undescended testes present and are treated late in Tikur Anbesa Hospital. As opposed to the literatures most of the undescended testes were found on the left side. Ultrasound examination cannot be the only mode of examination for undescended testes as it misses more than one third of the cases. Hypospadia is the commonest associated congenital malformation. Post operative follow up is very poor after treatment for undescended teste

Minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela, northeast Ethiopia: a community-based cross-sectional study

The first 2 years of life are a critical window of opportunity for ensuring optimal child growth and development. In Ethiopia, the magnitude of the minimum acceptable diet ranges from 7 to 74⋅6 %. The evidence revealed the variation and unrelated data on the prevalence of minimum acceptable diet. Therefore, the present study aimed to assess the minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela town administration, northeast Ethiopia. A community-based cross-sectional study was conducted in Lalibela town administration, northeast Ethiopia among 387 mothers/caregivers with children aged 6–23 months from May 1 to 30, 2022. The data were entered by Epidata version 3.1 and analysed by SPSS version 25.0. A multivariable binary logistic regression model was fitted to identify factors associated with minimum acceptable diet. The degrees of association were assessed using an adjusted odds ratio with a 95 % confidence interval and P-value of 0⋅05. The magnitude of minimum acceptable diet in the study area was 16⋅7 % (95 % confidence interval: 12⋅8–20⋅6 %). Sex of child, getting infant and young child feeding counselling at antenatal care, infant feeding practice-related knowledge and childhood illness are the variables that were found to be an independent predictor of minimum acceptable diet. Health facilities should strengthen infant feeding counselling starting from antenatal care visits during pregnancy for the recommended minimum acceptable diet is crucial

Hypospadias Repair in Ethiopia: A Five Year Review

BACKGROUND: Hypospadias repair is one of the problematic issues in pediatric surgery. As a result of the multiple complications following the procedure, a variety of techniques have been used and newer methods continue to emerge. There is still controversy regarding the best method of repair. We aimed to determine the outcome of surgery and factors contributing to unfavorable outcomes in children with hypospadias.MATERIALS AND METHODS: This is a retrospective review undertaken from September 2009 to August 2014. The research was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. All children who underwent hypospadias repair and had regular follow-up were included in the study.RESULTS: A total of 202 boys aged less than 13 years were assessed. Most surgeries (80.3%) were performed in children older than 18 months. Transverse incised plate urethroplasty (TIP) was frequently performed for distal hypospadias (71.2 %), while transverse ventral preputal flap (TVPF) was the most common procedure done for proximal hypospadias (62.8 %). Overall success rate for first surgery was 55.9 %. There was a high rate of major post-operative complications (44.1%) of which urethrocutaneous fistula (UCF) was the most common (31.2%) followed by meatal stenosis and glans breakdown (7.4 % each). These complications were found to be higher in those who were operated at a later age and those with proximal hypospadias (p=0.03 and p=0.01 respectively). There was also a significant difference among the type of procedures with TIP and TVPF having the least complications (p&lt;0.01).CONCLUSION: From our experience, we found TIP a relatively safe and reliable method of repair for distal hypospadias while TVPF single stage repair was superior in the proximal ones. The high rate of complications in our institution was associated with higher burden of severe hypospadias and older age at surgery.

Breeding Sites of Aedes aegypti

Background and Objectives. Entomological survey was carried out from May-June to September-October 2014 to investigate the presence of dengue vectors in discarded tires and artificial water containers in houses and peridomestic areas. Methods. A cross-sectional immature stage survey was done indoors and outdoors in 301 houses. Mosquito larval sampling was conducted using pipette or dipper depending on container types. Larvae were identified morphologically and larval indices were also calculated. Results. A total of 750 containers were inspected, and of these 405 were positive for mosquito larvae. A total of 1,873 larvae were collected and morphologically identified as Aedes aegypti (n=1580: 84.4%) and Culex (n=293: 15.6%). The larval indices, house index, container index, and breteau index, varied from 33.3 to 86.2, from 23.2 to 73.9, and from 56.5 to 188.9, respectively. Conclusion. Aedes aegypti is breeding in a wide range of artificial containers. To control these mosquitoes, the integration of different methods should be taken into consideration

Early Outcome of Laparotomy Wounds in Pediatric Patients in TASH, Addis Ababa, Ethiopia: A Six-Months Prospective Study

BACKGROUND፡ Surgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.METHODS: We performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher’s exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.RESULTS: Of 114 patients, median age was 46 months [range: 1day-13years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, &gt;1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96,p=0.003). Age (p=0.004) and malnutrition (p&lt;0.001) were significantly associated with wound dehiscence.CONCLUSION: SSI and wound dehiscence are common in this setting. Wound contamination, antibiotics administration &gt;1 hour before surgery and operative time &gt;2 hours are independent predictors of SSI

Multiple Origins and Regional Dispersal of Resistant dhps in African Plasmodium falciparum Malaria

Cally Roper and colleagues analyze the distribution of sulfadoxine resistance mutations and flanking microsatellite loci to trace the emergence and dispersal of drug-resistant Plasmodium falciparum malaria in Africa

Multiple Insecticide Resistance: An Impediment to Insecticide-Based Malaria Vector Control Program

BACKGROUND: Indoor Residual Spraying (IRS), insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are key components in malaria prevention and control strategy. However, the development of resistance by mosquitoes to insecticides recommended for IRS and/or ITNs/LLINs would affect insecticide-based malaria vector control. We assessed the susceptibility levels of Anopheles arabiensis to insecticides used in malaria control, characterized basic mechanisms underlying resistance, and evaluated the role of public health use of insecticides in resistance selection. METHODOLOGY/PRINCIPAL FINDINGS: Susceptibility status of An. arabiensis was assessed using WHO bioassay tests to DDT, permethrin, deltamethrin, malathion and propoxur in Ethiopia from August to September 2009. Mosquito specimens were screened for knockdown resistance (kdr) and insensitive acetylcholinesterase (ace-1(R)) mutations using AS-PCR and PCR-RFLP, respectively. DDT residues level in soil from human dwellings and the surrounding environment were determined by Gas Chromatography with Electron Capture Detector. An. arabiensis was resistant to DDT, permethrin, deltamethrin and malathion, but susceptible to propoxur. The West African kdr allele was found in 280 specimens out of 284 with a frequency ranged from 95% to 100%. Ace-1(R) mutation was not detected in all specimens scored for the allele. Moreover, DDT residues were found in soil samples from human dwellings but not in the surrounding environment. CONCLUSION: The observed multiple-resistance coupled with the occurrence of high kdr frequency in populations of An. arabiensis could profoundly affect the malaria vector control programme in Ethiopia. This needs an urgent call for implementing rational resistance management strategies and integrated vector control intervention

Evidence for a role of Anopheles stephensi in the spread of drug- and diagnosis-resistant malaria in Africa

Anopheles stephensi, an Asian malaria vector, continues to expand across Africa. The vector is now firmly established in urban settings in the Horn of Africa. Its presence in areas where malaria resurged suggested a possible role in causing malaria outbreaks. Here, using a prospective case-control design, we investigated the role of An. stephensi in transmission following a malaria outbreak in Dire Dawa, Ethiopia in April-July 2022. Screening contacts of patients with malaria and febrile controls revealed spatial clustering of Plasmodium falciparum infections around patients with malaria in strong association with the presence of An. stephensi in the household vicinity. Plasmodium sporozoites were detected in these mosquitoes. This outbreak involved clonal propagation of parasites with molecular signatures of artemisinin and diagnostic resistance. To our knowledge, this study provides the strongest evidence so far for a role of An. stephensi in driving an urban malaria outbreak in Africa, highlighting the major public health threat posed by this fast-spreading mosquito