Urethral Stricture and HIV: Unusual Presentations and Treatment Challenge

Objective: The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture.Patients and Methods: Consecutive men with urethral stricture who presented to the University Hospital of Gondar, North-West Ethiopia were enrolled. The HIV status, cause of the stricture, type of treatment and outcome were recorded.Results: There were 25 post-traumatic and 15 post-gonococcal urethral strictures. All posttraumatic and 5 of the post-gonococcal urethral stricture patients were HIV negative. All 10 HIV positive patients had longer and denser urethral strictures than expected. The time between gonococcal infection and urethral stricture development was 3-5 years in HIV positive patients. The treatment of post-traumatic stricture included progressive perineal anastomotic urethroplasty and a good outcome was seen in more than 95%. However, the surgical treatment of patients with HIV infection was a challenge.Conclusion: If post-inflammatory urethral stricture occurs in a young man where the time between known gonococcal infection and development of stricture is short (less than 5 years), HIV coinfection is most likely. The stricture in these patients will be longer and denser and not amenableto conventional endoscopic urethrotomy.Key Words: Urethral stricture, gonococcal infection, trauma, treatment, HI

A systematic review and meta-analysis of trypanosome prevalence in tsetse flies

Background: The optimisation of trypanosomosis control programs warrants a good knowledge of the main vector of animal and human trypanosomes in sub-Saharan Africa, the tsetse fly. An important aspect of the tsetse fly population is its trypanosome infection prevalence, as it determines the intensity of the transmission of the parasite by the vector. We therefore conducted a systematic review of published studies documenting trypanosome infection prevalence from field surveys or from laboratory experiments under controlled conditions. Publications were screened in the Web of Science, PubMed and Google Scholar databases. Using the four-stage (identification, screening, eligibility and inclusion) process in the PRISMA statement the initial screened total of 605 studies were reduced to 72 studies. The microscopic examination of dissected flies (dissection method) remains the most used method to detect trypanosomes and thus constituted the main focus of this analysis. Meta-regression was performed to identify factors responsible for high trypanosome prevalence in the vectors and a random effects meta-analysis was used to report the sensitivity of molecular and serological tests using the dissection method as gold standard. Results: The overall pooled prevalence was 10.3% (95% confidence interval [CI] = 8.1%, 12.4%) and 31.0% (95% CI = 20. 0%, 42.0%) for the field survey and laboratory experiment data respectively. The country and the year of publication were found to be significantly factors associated with the prevalence of trypanosome infection in tsetse flies. The alternative diagnostic tools applied to dissection positive samples were characterised by low sensitivity, and no information on the specificity was available at all. Conclusion: Both temporal and spatial variation in trypanosome infection prevalence of field collected tsetse flies exists, but further investigation on real risk factors is needed how this variation can be explained. Improving the sensitivity and determining the specificity of these alternative diagnostic tools should be a priority and will allow to estimate the prevalence of trypanosome infection in tsetse flies in high-throughput

Dog bite as a public health concern in Addis Ababa

Introduction: Animal bites and scratches represent the most important public health issue related to dogs and cats because of the risk of rabies transmission associated with physical, psychological trauma and wound infection. Objective: The study was aimed at estimating the prevalence of animal bite of human beings in Addis Ababa. Methods: Data on the kind of animal, age of the patients, gender, site of bites and /or scratch were collected from the registry book and analyzed using SPSS version 11.5. Results: A total of 1299 cases of bite and/or scratch were reported for the period September 2008 to August 2009. The majority of bites were made by dogs where stray dogs are much higher (X2 = 0.83, p= 0.36). There is statistically highly significant difference of bites between sex (p = 0.001) and between age group (F = 5.41, p=0.02). The animal bite made by dogs was higher on legs (55.6 %) followed by hands (26.45 %) and multiple bites (7.51 %). Conclusions: The majority of bites were attributed to stray dogs followed by cats, horses, donkeys. To reduce the problem a preventative public education is suggested

Seroprevalence and participatory epidemiology of camelpox in Afar region of Ethiopia

Camelpox is endemic in most camel rearing regions of the world, causing significant economic losses. However, its epidemiology is not extensively investigated. We conducted a cross sectional seroprevalence study of camelpox in Amibara and Awash Fentale districts in Afar region of Ethiopia from November 2014 to May 2015. In addition, participatory epidemiology (PE) was conducted to identify seasonal occurrence of the disease in the study districts. Blood samples were collected from 384 dromedary camels from 31 herds distributed in five pastoral associations (PAs) in the two districts. Serum samples were separated from the blood samples and tested for the presence of viral antibodies using virus neutralization test. Seroprevalence data were analyzed using multilevel mixed effects logistic regression models accounting for the 4-level hierarchical data structure (camels nested in herds-herds in PA, and PA in district). For the participatory data, Kendall’s coefficient of concordance was used to assess agreements between the informants in identifying seasonal occurrences of the top five camel diseases. Camelpox antibodies were detected in 19.3% of camels (n = 384), 81% of herds (n = 31), and in all five PAs from the two districts in the Gabi Rasu zone of Afar region, Ethiopia. The seroprevalence did not significantly vary between herds, PAs or districts suggesting the widespread occurrence of the disease. Estimated age stratified basic reproduction number (R0) was 1.25 (95% CI: 0.62–2.19). Camelpox was identified as one of the top five common camel diseases in the area. The widespread occurrence of the disease can be attributed mainly to the commingling of camels from many herds during seasonal migration in search of feed and water, a practice very common under pastoral production systems. Although the PE informants indicated the clinical disease to be more common in young animals, seropositivity was higher in older animals. Camelpox commonly occurs during the minor and major rainy seasons. In conclusion, camelpox is found to be endemic in Afar pastoral region with sporadic outbreaks occurring during rainy seasons. Vaccination and improved camel management practices particularly during the high-risk period can be viable strategies to reduce the burden of the disease

Characteristics and Early Outcomes of Patients With Xpert MTB/RIF-Negative Pulmonary Tuberculosis Diagnosed During Screening Before Antiretroviral Therapy

Comparison of the characteristics of HIV-infected patients with Xpert-positive and Xpert-negative tuberculosis and relationship of Xpert status with subsequent clinical and programmatic outcomes

Assessment of Handling Practices, Utilization and Concentration of Iodine in Iodized Salt at Wondo Genet town, Southern Ethiopia: A Crossectional Study

Iodine deficiency is severe public health problem in Ethiopia. One out of every 1000 population is mentally handicapped due to a congenital thyroid deficiency, and about 50,000 prenatal deaths are occurring annually due to iodine deficiency disorders.nbsp Even though the problem is serious, there were no adequate researches conducted. Therefore, this study focuses on assessment of handling practices of iodized salt and the amount of iodine concentration retained in iodized salts at households and retailers level in Wondo Genet town. The objective of this study was to assess handling practices and concentration of iodine across iodized salt consumption in retailers and households level. Two hundred ninety four households and seventh six retailers were selected by systematic random sampling method for survey using questionnaire and rapid test kit method was used to measure iodine concentration of salt used by the households. The result of this study indicated that iodized salt coverage was found to be 100 % at households and retailers level. Iodine level in the salt examined by iodometric titration, in this study was 4.4 to 70.9 ppm. This indicates the need for further improvement of handling practices of iodized salt. Iodine level in the salt examined by iodometric titration in this study was 60.54% of households and 65.79% retailers salt samples had 15 ndash 40 ppm iodine concentration. This shows that in the iodized salt there is no adequate iodine content in accordance with the nbsprecommendation. Majority of the households 37.4% add iodized salt half way during boiling of the food/coffee. Although the coverage of iodized salt in the study area was high but availability of adequate iodized salt at household level was low as compared to the WHO recommendation.There for this shows that handling practice of iodized salt at the household and retailer level and utilization practice at the household level is poor

Uteroplacental bleeding disorders during pregnancy: do missing paternal characteristics influence risk?

BACKGROUND: Several studies have assessed the risks of uteroplacental bleeding disorders in relation to maternal characteristics. The association between uteroplacental bleeding disorders and paternal characteristics, however, has received considerably less attention. Data on paternal demographics, notably race and age, from birth certificate data are becoming increasingly incomplete in recent years. This pattern of increasingly underreporting of paternal demographic data led us to speculate that pregnancies for which paternal characteristics are partially or completely missing may be associated with increased risk for uteroplacental bleeding disorders. The objective of this study is to examine the association between placenta previa and placental abruption and missing paternal age and race. METHODS: A retrospective cohort study using U.S. linked birth/infant death data from 1995 through 2001 (n = 26,336,549) was performed. Risks of placenta previa and placental abruption among: (i) pregnancies with complete paternal age and race data; (ii) paternal age only missing; (iii) paternal race only missing; and (iv) both paternal age and race missing, were evaluated. Relative risk (RR) with 95% confidence interval (CI) for placenta previa and placental abruption by missing paternal characteristics were derived after adjusting for confounders. RESULTS: Adjusted RR for placental abruption were 1.30 (95% CI 1.24, 1.37), 1.00 (95% CI 0.95, 1.05), and 1.08 (95% CI 1.06, 1.10) among pregnancies with "paternal age only", "paternal race only", and "both paternal age and race" missing, respectively. The increased risk of placental abruption among the "paternal age only missing" category is partly explained by increased risks among whites aged 20–29 years, and among blacks aged ≥30 years. However, no clear patterns in the associations between missing paternal characteristics and placenta previa were evident. CONCLUSION: Missing paternal characteristics are associated with increased risk of placental abruption, likely mediated through low socio-economic conditions

Changes in soil properties following the establishment of exclosures in Ethiopia : a meta-analysis

Acknowledgements This work is part of the RALENTIR (Reducing land degradation and carbon loss from Ethiopia's soils to strengthen livelihoods and resilience) project, funded by GCRF (Global Challenges Research Fund) and University of Aberdeen. We are grateful to Abeyou Wale for his assistance in developing the map of agroecological zones of Ethiopia.Peer reviewedPublisher PD

Assessment of Handling Practices, Utilization and Concentration of Iodine in Iodized Salt at Wondo Genet town, Southern Ethiopia: A Crossectional Study

Iodine deficiency is severe public health problem in Ethiopia. One out of every 1000 population is mentally handicapped due to a congenital thyroid deficiency, and about 50,000 prenatal deaths are occurring annually due to iodine deficiency disorders.nbsp Even though the problem is serious, there were no adequate researches conducted. Therefore, this study focuses on assessment of handling practices of iodized salt and the amount of iodine concentration retained in iodized salts at households and retailers level in Wondo Genet town. The objective of this study was to assess handling practices and concentration of iodine across iodized salt consumption in retailers and households level. Two hundred ninety four households and seventh six retailers were selected by systematic random sampling method for survey using questionnaire and rapid test kit method was used to measure iodine concentration of salt used by the households. The result of this study indicated that iodized salt coverage was found to be 100 % at households and retailers level. Iodine level in the salt examined by iodometric titration, in this study was 4.4 to 70.9 ppm. This indicates the need for further improvement of handling practices of iodized salt. Iodine level in the salt examined by iodometric titration in this study was 60.54% of households and 65.79% retailers salt samples had 15 ndash 40 ppm iodine concentration. This shows that in the iodized salt there is no adequate iodine content in accordance with the nbsprecommendation. Majority of the households 37.4% add iodized salt half way during boiling of the food/coffee. Although the coverage of iodized salt in the study area was high but availability of adequate iodized salt at household level was low as compared to the WHO recommendation.There for this shows that handling practice of iodized salt at the household and retailer level and utilization practice at the household level is poor

Factors predictive of successful retention in care among HIV-infected men in a universal test-and-treat setting in Uganda and Kenya: A mixed methods analysis.

BackgroundPrevious research indicates clinical outcomes among HIV-infected men in sub-Saharan Africa are sub-optimal. The SEARCH test and treat trial (NCT01864603) intervention included antiretroviral care delivery designed to address known barriers to HIV-care among men by decreasing clinic visit frequency and providing flexible, patient-centered care with retention support. We sought to understand facilitators and barriers to retention in care in this universal treatment setting through quantitative and qualitative data analysis.MethodsWe used a convergent mixed methods study design to evaluate retention in HIV care among adults (age > = 15) during the first year of the SEARCH (NCT01864603) test and treat trial. Cox proportional hazards regression was used to evaluate predictors of retention in care. Longitudinal qualitative data from n = 190 in-depth interviews with HIV-positive individuals and health care providers were analyzed to identify facilitators and barriers to HIV care engagement.ResultsThere were 1,863 men and 3,820 women who linked to care following baseline testing. Retention in care was 89.7% (95% CI 87.0-91.8%) among men and 89.0% (86.8-90.9%) among women at one year. In both men and women older age was associated with higher rates of retention in care at one year. Additionally, among men higher CD4+ at ART initiation and decreased time between testing and ART initiation was associated with higher rates of retention. Maintaining physical health, a patient-centered treatment environment, supportive partnerships, few negative consequences to disclosure, and the ability to seek care in facilities outside of their community of residence were found to promote retention in care.ConclusionsFeatures of the ART delivery system in the SEARCH intervention and social and structural advantages emerged as facilitators to retention in HIV care among men. Messaging around the health benefits of early ART start, decreasing logistical barriers to HIV care, support of flexible treatment environments, and accelerated linkage to care, are important to men's success in ART treatment programs. Men already benefit from increased social support following disclosure of their HIV-status. Future efforts to shift gender norms towards greater equity are a potential strategy to support high levels of engagement in care for both men and women