The magnitude and correlates of internalized stigma among people with mental illness attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

Introduction: Internalized stigma is an ongoing process of psychological assimilation of the community labels towards mental illness, in which people with mental illness (PWMI) gradually lose their current positive belief and confidence in themselves and their future wishes. It affects the treatment and help-seeking behavior which leads to poor drug adherence, social marginalization, unemployment, socio-economic devastation, and poor quality of life for PWMI. Therefore, the current study aimed to determine the magnitude and correlates of high internalized stigma among People with Mental Illness (PWMI) attending the outpatient department of Amanuel mental specialized hospital, Addis Ababa, Ethiopia. Methods: Institution based cross-sectional study was conducted from March 03 to March 28, 2019. A consecutive sampling technique was used to select an estimated 406 study participants. Internalized stigma was assessed using a 29 Item Internalized Stigma of Mental Illness (ISMI-29) tool. Data were entered and analyzed using SPSS 22 software. A Binary logistic regression model was fitted to identify correlates of internalized stigma. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the strength of association and the level of significance was declared with a p-value <0.05. Result: Of the total study participants, 388 respondents agreed to participate in the study giving a response rate of 96%. The magnitude of high internalized stigma among the study participants was 61.3% (95% CI: 58.2, 64.4). Poor social support (AOR = 1.973; 95%CI = 1.189, 3.27) and being unemployed (AOR = 2.87, 95% CI = 1.192-6.931) were significant correlates of high internalized stigma among PWMI. Conclusion: Overall, around three in five PWMI experienced high internalized stigma. Poor social support and being unemployed were significant correlates of high internalized stigma. Large scale community-based study supplemented by qualitative design is highly recommended to identify additional correlates of internalized stigma and understand perspectives of PWMI

The Experience of Incarcerated Mothers Living in a Correctional Institution with their Children in Ethiopia

The needs of female inmates are different from those of their male counterparts. Little is understood of the nature of these differences, particularly for mothers who in countries such as Ethiopia may be accompanied by their children when in correctional facilities. This article is aimed at exploring these inmates’ experiences of motherhood, the challenges they and their children face and their experiences of the services and support programmes available. The central research question was: ‘What is the experience of incarcerated mothers living in prison with their children in Ethiopia?’ A general qualitative approach was taken in the study, using in-depth interviews (n=10) with incarcerated mothers who had a child living with them in a typical large, high-security Ethiopian correctional institution. Mothers questioned the perceived inclusiveness of the services available to them, with access often being denied owing to their childcare responsibilities. Participation in small business enterprises within the institution was an exception to this. They discussed the challenges facing the mother and child as a family unit, the relationship between the mother, the criminal justice system and society and finally their perceptions of the incarcerated mother as a survivor, resilient in the face of the challenges being experienced. These themes showed that incarcerated mothers perceive themselves as victims of societal discrimination, abuse and structural injustice before and after incarceration, and that correctional institution facilities left them unable to provide adequately for the physical, emotional and educational needs of their children. The role of correctional administrations, policymakers, correctional institution social workers and researchers alike in addressing the inequalities facing mothers in Ethiopian correctional institutions is discussed

The Lived Experience of Motherhood After Prison: A Qualitative Systematic Review

Despite the increasing number of women experiencing incarceration internationally, their experiences of motherhood after prison rarely studied. This review aims to explore and synthesise current research on the nature of the lived experience of motherhood after imprisonment. A qualitative synthesis review of English language-based articles published before January 2020 was used. 14 peer-reviewed qualitative studies were identified. The findings indicate that the post-release was a time when mothers re-claim their mothering role but faced significant challenges without sufficient support systems. It was also a time of reflection on the impact that the context of incarceration had on parenting roles and relationships with their children. The review found that we have limited understanding of the mothers' current experiences of motherhood post-release. The reports are also insufficient to capture the mothers' voice in different contexts. Further research is therefore required to explore the motherhood experience after release in greater depth and richness

Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia

Background Utilization of long-lasting insecticidal nets (LLINs) is regarded as key malaria prevention and control strategy. However, studies have reported a large gap in terms of both ownership and utilization particularly in the sub-Saharan Africa (SSA). With continual efforts to improve the use of LLIN and to progress malaria elimination, examining the factors influencing the ownership and usage of LLIN is of high importance. Therefore, the current study was conducted to examine the level of ownership and use of LLIN along with identification of associated factors at household level. Methods A cross-sectional study was conducted in Mirab Abaya District, Southern Ethiopia in June and July 2014. A total of 540 households, with an estimated 2690 members, were selected in four kebeles of the district known to have high incidence of malaria. Trained data collectors interviewed household heads to collect information on the knowledge, ownership and utilization of LLINs, which was complemented by direct observation on the conditions and use of the nets through house-to-house visit. Bivariate and multivariable logistic regression analyses were used to determine factors associated to LLIN use. Results Of 540 households intended to be included in the survey, 507 responded to the study (94.24% response rate), covering the homes of 2759 people. More than 58% of the households had family size >5 (the regional average), and 60.2% of them had at least one child below the age of 5 years. The ownership of at least one LLIN among households surveyed was 89.9%, and using at least one LLIN during the night prior to the survey among net owners was 85.1% (n = 456). Only 36.7% (186) mentioned at least as the mean of correct scores of all participants for 14 possible malaria symptoms and 32.7% (166) knew at least as the mean of correct scores of all participants for possible preventive methods. Over 30% of nets owned by the households were out of use. After controlling for confounding factors, having two or more sleeping places (adjusted odds ratio [aOR] = 2.58, 95% CI 1.17, 5.73), knowledge that LLIN prevents malaria (aOR = 2.51, 95% CI 1.17, 5.37), the presence of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and walls of the house plastered or painted >12 months ago (aOR = 0.09, 95% CI 0.01, 0.71) were important predictors of LLIN utilization. Conclusions This study found a higher proportion of LLIN ownership and utilization by households than had previously been found in similar studies in Ethiopia, and in many studies in SSA. However, poor knowledge of the transmission mechanisms and the symptoms of malaria, and vector control measures to prevent malaria were evident. Moderate proportions of nets were found to be out of use or in poor repair. Efforts should be in place to maintain the current rate of utilization of LLIN in the district and improve on the identified gaps in order to support the elimination of malaria

Performance of QuantiFERON-TB Gold In-Tube (QFTGIT) for the diagnosis of Mycobacterium tuberculosis (Mtb) infection in Afar Pastoralists, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Currently, T-cell based gamma interferon (IFNγ) release assays (IGRAs) are acknowledged as the best methods available for the screening of latent tuberculosis infection (LTBI) and also as aid for the diagnosis of active tuberculosis (TB). To our information, the performance of these diagnostic tests has not been evaluated in Ethiopia. Therefore, the intent of this study was to evaluate the performance of QuantiFERON-TB Gold In-Tube (QFTGIT) in patients clinically suspected of active pulmonary TB (PTB) as well as in healthy subjects prior to its utilization for the epidemiological study of active TB and LTBI in Afar pastoralists.</p> <p>Methods</p> <p>The sensitivity of QFTGIT was evaluated in 140 subjects who were clinically suspected of PTB using the cut-off value recommended by the manufacturer (≥ 0.35 IU/ml) and disease-specific cut-off value. Sputum culture result was used as a gold standard. The specificity of the test was evaluated both in patients and in 55 tuberculin skin test (TST) negative healthy subjects.</p> <p>Results</p> <p>Out of the 140 study participants, 37 (26.4%) were positive for active PTB by culture. Out of the 37 subjects who had positive results by culture, 6 individuals were HIV-seropositive. Out of the 103 subjects who were negative by culture, 6 subjects had indeterminate results and 21 were HIV-seropositive. The performance of the test was assessed using data from 107 (31 culture positive and 76 culture negative) individuals who were clinically suspected of PTB and HIV-seronegatives. Using the manufacturer recommended cut-off value, the sensitivity of the test was 64.5% (20/31), while its specificity was 36.8% (28/76). The sensitivity of the test was increased to 77.4%, while the specificity was reduced to 23.7% using a cut-off value ≥ 0.1 IU/ml of IFNγ as disease-specific cut-off value. In TST negative healthy subjects, the specificity of the test was 58.2%.</p> <p>Conclusion</p> <p>Our findings revealed a low sensitivity of QFTGIT in the diagnosis of <it>Mycobacterium tuberculosis (Mtb) </it>infection in the present study area using the cut-off value recommended by the manufacturer. Nevertheless, the sensitivity increased from 64.5% to 77.4% by lowering the cut-off value recommended by the manufacturer to ≥ 0.1 IU/ml of IFNγ level. Hence, it is of practical importance to evaluate the performance of QFTGIT in population under different settings prior to its application either for the diagnosis of active TB or LTBI.</p

Knowledge of cervical tuberculosis lymphadenitis and its treatment in pastoral communities of the Afar region, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Infection with <it>Mycobacterium bovis </it>(Mb) predominantly causes cervical TB lymphadenitis (TBL). Raw milk is considered the main source of Mb infection and raw milk is a major food source for Afar pastoralists. The aim of this study was to assess Afar pastoralists' knowledge concerning cervical TBL and its treatment.</p> <p>Methods</p> <p>A community-based cross-sectional survey involving 818 interviewees was conducted in two districts of the Afar Region, Ethiopia. In addition, two focus group discussions (FGDs) were conducted in each of the study areas, one with men and the other with women.</p> <p>Results</p> <p>Of the 818 interviewees [357 (43.6%) females and 461 (56.4%) males], 742 (90.7%) reported that they had knowledge of cervical TBL, mentioning that swelling(s) on the neck resulting in a lesion and scar are common symptoms. However, only 11 (1.5%) individuals mentioned that bacteria or germs are the causative agents of TBL. Three interviewees and a male discussant mentioned drinking raw milk as the cause of TBL. A considerable proportion (34.2%) of the interviewees and almost all the discussants suggested herbal medicine as an effective treatment. Male study participants were 1.82 times more likely to have overall knowledge of TBL than female study participants (adjusted OR, 1.82; 95% CI, 1.32 to 2.51, p < 0.001).</p> <p>Conclusion</p> <p>The pastoral community members in the study areas had little biomedical knowledge of the cause, the source of infection and the transmission route of cervical TBL. Furthermore, most community members believed that herbal medicines are the most effective treatment for TBL. Therefore, TB control programs in the Afar Region require the incorporation of public health education introducing current biomedical knowledge of the disease. In addition, further studies are important to elucidate which medicinal plants are used by Afar pastoralists to treat TBL.</p

In vivo efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in Central Ethiopia

<p>Abstract</p> <p>Background</p> <p><it>In vivo </it>efficacy assessments of the first-line treatments for <it>Plasmodium falciparum </it>malaria are essential for ensuring effective case management. In Ethiopia, artemether-lumefantrine (AL) has been the first-line treatment for uncomplicated <it>P. falciparum </it>malaria since 2004.</p> <p>Methods</p> <p>Between October and November 2009, we conducted a 42-day, single arm, open label study of AL for <it>P. falciparum </it>in individuals >6 months of age at two sites in Oromia State, Ethiopia. Eligible patients who had documented <it>P. falciparum </it>mono-infection were enrolled and followed according to the standard 2009 World Health Organization <it>in vivo </it>drug efficacy monitoring protocol. The primary and secondary endpoints were PCR uncorrected and corrected cure rates, as measured by adequate clinical and parasitological response on days 28 and 42, respectively.</p> <p>Results</p> <p>Of 4426 patients tested, 120 with confirmed falciparum malaria were enrolled and treated with AL. Follow-up was completed for 112 patients at day 28 and 104 patients at day 42. There was one late parasitological failure, which was classified as undetermined after genotyping. Uncorrected cure rates at both day 28 and 42 for the per protocol analysis were 99.1% (95% CI 95.1-100.0); corrected cure rates at both day 28 and 42 were 100.0%. Uncorrected cure rates at day 28 and 42 for the intention to treat analysis were 93.3% (95% CI 87.2-97.1) and 86.6% (95% CI 79.1-92.1), respectively, while the corrected cure rates at day 28 and 42 were 94.1% (95% CI 88.2-97.6) and 87.3% (95% CI 79.9-92.7), respectively. Using survival analysis, the unadjusted cure rate was 99.1% and 100.0% adjusted by genotyping for day 28 and 42, respectively. Eight <it>P. falciparum </it>patients (6.7%) presented with <it>Plasmodium vivax </it>infection during follow-up and were excluded from the per protocol analysis. Only one patient had persistent parasitaemia at day 3. No serious adverse events were reported, with cough and nausea/vomiting being the most common adverse events.</p> <p>Conclusions</p> <p>AL remains a highly effective and well-tolerated treatment for uncomplicated falciparum malaria in the study setting after several years of universal access to AL. A high rate of parasitaemia with <it>P. vivax </it>possibly from relapse or new infection was observed.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01052584">NCT01052584</a></p

Seasonal flows of international British Columbia-Alaska rivers: The nonlinear influence of ocean-atmosphere circulation patterns

The northern portion of the Pacific coastal temperate rainforest (PCTR) is one of the least anthropogenically modified regions on earth and remains in many respects a frontier area to science. Rivers crossing the northern PCTR, which is also an international boundary region between British Columbia, Canada and Alaska, USA, deliver large freshwater and biogeochemical fluxes to the Gulf of Alaska and establish linkages between coastal and continental ecosystems. We evaluate interannual flow variability in three transboundary PCTR watersheds in response to El Niño-Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO), Arctic Oscillation (AO), and North Pacific Gyre Oscillation (NPGO). Historical hydroclimatic datasets from both Canada and the USA are analyzed using an up-to-date methodological suite accommodating both seasonally transient and highly nonlinear teleconnections. We find that streamflow teleconnections occur over particular seasonal windows reflecting the intersection of specific atmospheric and terrestrial hydrologic processes. The strongest signal is a snowmelt-driven flow timing shift resulting from ENSO- and PDO-associated temperature anomalies. Autumn rainfall runoff is also modulated by these climate modes, and a glacier-mediated teleconnection contributes to a late-summer ENSO-flow association. Teleconnections between AO and freshet flows reflect corresponding temperature and precipitation anomalies. A coherent NPGO signal is not clearly evident in streamflow. Linear and monotonically nonlinear teleconnections were widely identified, with less evidence for the parabolic effects that can play an important role elsewhere. The streamflow teleconnections did not vary greatly between hydrometric stations, presumably reflecting broad similarities in watershed characteristics. These results establish a regional foundation for both transboundary water management and studies of long-term hydroclimatic and environmental change

PFGE XbaI® Indistinguishable properties of Salmonella Kastrup and Salmonella Larochelle isolates at beef processing and distribution continuum

Salmonellosis is a major cause of foodborne illnesses in humans throughout the world. Pulsed field gel electrophoresis (PFGE) is a commonly used tool for epidemiological survey and source tracking of Salmonella strains isolated from various sources. A total of 237 samples from various sources were collected at abattoir and butcheries in Ethiopia from December 2011 to April 2012. Isolates of Salmonella Kastrup (n = 3) and Salmonella Larochelle (n = 11) were characterized for antimicrobial resistance using disc diffusion and for genotypic profiles using PFGE XbaI®. Salmonella Kastrup and S. Larochelle were isolated from 1.3% and 4.6% of total samples (n = 237) examined. Except for water samples (n = 12) and truck swabs (n=11), all other sample sources were positive for one or more of S. Kastrup and S. Larochelle. Salmonella Kastrup was isolated in Ethiopia for the first time. Salmonella isolates from both Kastrup and Larochelle serotypes showed similar antimicrobial resistance profiles. Two pulsotypes consisting of the same three S. Kastrup and 10 S. Larochelle cluster and second cluster consisting of one S. Larochelle were identified at 1.5% and 1% band positions tolerance by unweighted-pair group method (UPGM) and showed ≥91% similarity. S. Kastrup and S. Larochelle isolates showed similar antimicrobial resistance profiles with indistinguishable PFGE XbaI® patterns indicating possible clonal spread of the isolates along beef processing and distribution continuum.Key words: Salmonella; PFGE; Antimicrobial resistance; Beef; Ethiopi

Machine Learning-Based Techniques for Assessing Critical Factors for European Tick Abundance

Tick-borne diseases are a significant health risk to humans and animals worldwide. It is important to understand the environmental and climatic factors that contribute to tick occurrence rates in order to reduce the proliferation of tick borne diseases. Using machine learning and spatial indexing techniques, this study covers tick occurrence rates in Europe over the last 20 years to understand the environmental and climatic factors that contribute to Ixodes ricinus tick abundance. We used biodiversity databases to study land cover categories, climate, vegetation index, and sociological factors. Areas with agriculture and natural vegetation, especially broad-leaved forests, had the strongest tick correlation. Waterways and pastures also showed significant positive correlations, indicating tick habitats. Ticks have moderate associations with urban green spaces, industrial units, and mixed forests suggesting their presence in ecologically disturbed habitats. Geoclimatic factors namely Normalised Difference Vegetation Index and rainfall, showed weak to negative correlations with tick population, indicating that they were less important than previously assumed. Linear Regression, Decision Tree, Random Forest, and Support Vector Machine were compared. We found that feature set and outlier presence significantly affected model performance. After removing outliers, Linear Regression performed best for land use features, with a R² value of 0.81, NRMSE of 1.56, SI of 1.56, and MAPE of 1.22. Outlier exclusion improved the model performance results. This research emphasises the importance of specific land uses in predicting the dynamics of tick population. Our findings lay the groundwork for focused intervention strategies to reduce the spread of tick-borne diseases using an innovative and intelligent approach, while also emphasising the need for further investigation into the complex interactions between environmental factors and tick abundance