THE TRAINING AND USE OF COMMUNITY HEALTH AGENTS IN ETHIOPIA

ABSTRACT The training of community health agents (CHAs) started in Ethiopia in 1978. Thus far, 4218 CH4s have been trained and deployed. A study covering 58 CHAs out of 1122 (5%) in three regions was conducted to evaluate the work of the CHAs before unidentified and/or unresolved problems arose which could jeopardize their future effectiveness. The study showed that the size of the population covered per CHA varied considerably among the three types of mass organizations. Support in the form of cash remuneration was most frequent in service cooperatives. Three-quarters of the peasants' associations provided no remuneration at all. Service cooperatives were most often able to supply drugs. Supervision by health units was high, although what that meant was not clear. Of the CHAs investigated, '62% had continued unbroken service, 17% of those initially selected as CHAs had not started work, and 21% discontinued work which gave a total attrition rate of 38%. The lack of full support by communities for community health services is noted, and some reasons are suggested

Evaluation of Sorghum for Salt Stress Tolerance Using Different Stages as Screening Tool in Raya Valley, Northern Ethiopia

አህፅሮት የአፈር ጨዋማነት በሰብሎች ላይ አሉታዊ ተፅዕኖ በመፍጠር ምርትና ምርታማነትን እንዲቀንስ ያደርጋል፡፡ በመሆኑም በራያ ተፋሰስ ይህ መነሻ በማድረግ የአፈር ጨዋማነትን ተቋቁመው የተሻለ ምርትና ምርታማነት ሊሰጡ የሚችሉ  የማሽላ ዝርያዎችን ከተለያዩ ማሽላ ኣብቃይ ከሆኑ አከባቢዎች በመሰብሰብ  የተለያዩ የጨው መጠን  (0, 10, 15 and 20 dS m-1) በመለካት በቤተ ጥናት ግሪንሃዉስ ተዘርቶ ከዚህ በማጣራት ደሞ ጨዋማ በሆነ መሬት ላይ በመዝራት ጨዋማነቱን በመም የተሻለ የመብቀል እና ምርት መስጠት የሚችሉ የማሽላ ዝርያዎች እንዲለዩ ተደርገዋል፡፡ ይህን የሚያመላክተዉ የአፈር ጨዋማነት እየጨመረ በሄደ ቁጥር የማሽላን የመብቀል አቅምና አጠቃላይ እድገቱን ይቀንሳል፡፡ በተመሳሳይ መልኩ የአፈር ጨዋማነት እየጨመረ በሄደ ቁጥር የማሽላን ምርትና ምርታማነቱን ይቀንሳል፡፡ ስለዚህ ሜኮ እና 76T1 ቁጥር 23 የተባሉ የማሽላ ዝርያዎች ለአከባቢው የአፈር ጨዋማነትን ተቋቁመው የተሻለ ምርትና ምርታማነትን ይጨምራሉ፡፡ በመሆኑም እነዚህን ሁለቱ የማሽላ ዝርያዎች ወደ ገበሬ ከመግባታቸው በፊት ሰፊ በሆኑ ማሳዎች ላይ ለገበሬዎች  የሰርቶ ማሳያ እና የማስተዋወቅ ስራ ሊሰራባቸው ይገባል፡፡     Abstract Salinity is one of the major environmental problem that lead to deterioration of agricultural land and, as a result, to reduction in crop productivity. Evaluation of sorghum varieties/lines for salt tolerance were conducted with the objectives to evaluate and identify salinity stress tolerance and to determine the effect of salinity at different levels of NaCl in Raya valley, northern Ethiopia. The screening procedures were conducted at three stages; germination, seedling and field experiment through exposing to salt stress condition. Initially, 46 varieties/lines of sorghum were placed in Petri plates using 0 and 20 dS m-1 level of NaCl and better performing were selected based on their total germination percentage and germination stress tolerance index. Then, control (0 dS m-1) and three salinity levels (10, 15 and 20 dS m-1) of NaCl were prepared at germination and seedling stages. Results indicated that, all investigated traits were affected by salt stress at germination and seedling stages. Similarly, soil salinity reduced yield and yield components of sorghum at field experiments. Both Meko and 76T1#23 were more yielded than the national average compared to the tested sorghum varieties in the two consecutive cropping seasons. Thus, Meko and 76T1#23 were promising varieties as indicated by all investigated traits and hence, recommended for yield and yield traits maximization Raya valley. Therefore, these varieties should be validated and demonstrated to more numbers of farmers in larger plots to recommend to extension users.&nbsp

Financial risk of road traffic trauma care in public and private hospitals in Addis Ababa, Ethiopia: A cross-sectional observational study

Background Road traffic injuries are among the most important causes of morbidity and mortality and cause substantial economic loss to households in Ethiopia. This study estimates the financial risks of seeking trauma care due to road traffic injuries in Addis Ababa, Ethiopia. Methods This is a cross-sectional survey on out-of-pocket (OOP) expenditures related to trauma care in three public and one private hospital in Addis Ababa from December 2018 to February 2019. Direct medical and non-medical costs (2018 USD) were collected from 452 trauma cases. Catastrophic health expenditures were defined as OOP health expenditures of 10% or more of total household expenditures. Additionally, we investigated the impoverishment effect of OOP expenditures using the international poverty line of $1.90 per day per person (adjusted for purchasing power parity). Results Trauma care seeking after road traffic injuries generate catastrophic health expenditures for 67$256 for outpatient visits and $690 for inpatient visits per road traffic injury. Patients paid more for trauma care in private hospitals, and OOP expenditures were six times higher in private than in public hospitals. Transport to facilities and caregiver costs were the two major cost drivers, amounting to$96 and $68 per patient, respectively. Conclusion Seeking trauma care after a road traffic injury poses a substantial financial threat to Ethiopian households due to lack of strong financial risk protection mechanisms. Ethiopia's government should enact multisectoral interventions for increasing the prevention of road traffic injuries and implement universal public finance of trauma care.publishedVersio

Intensive Care in Sub-Saharan Africa : A National Review of the Service Status in Ethiopia

Funding: This study was funded by the Ethiopian Ministry of Health Emergency and Critical Care Directorate. A.B. and R.H. are funded in whole, or in part, by the Wellcome Trust [220211] and UKRI GECO Grant MR/V030884/1 for their contribution to this study. ACKNOWLEDGMENTS The authors wish to thank all hospital CEO’s and medical directors for their honest and cooperative response, and data collectors and coordinators who visited facilities for their assistance with data col- lection. We thank Ermiyas Belay, MSc, from Wolkite University, Ethiopia, and Dilanthi Gamage from Network for Improving Critical Care Systems and Training (NICST), Sri Lanka for their assistance in analyzing the data. We are particularly grateful to Prof Bruce Biccard, PhD, from University of Cape Town for his assistance in presubmission manuscript review.Peer reviewedPublisher PD

The national programme to eliminate lymphatic filariasis from Ethiopia

Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia and is caused by Wuchereria bancrofti. Mapping for LF has shown that 70 woredas (districts) are endemic and 5.9 million people are estimated to be at risk. The national government’s LF elimination programme commenced in 2009 in 5 districts integrated with the onchocerciasis programme. The programme developed gradually and has shown significant progress over the past 6 years, reaching 100% geographical coverage for mass drug administration (MDA) by 2016. To comply with the global LF elimination goals an integrated morbidity management and disability prevention (MMDP) guideline and a burden assessment programme has also been developed; MMDP protocols and a hydrocoele surgical handbook produced for country-wide use. In Ethiopia, almost all LF endemic districts are co-endemic with malaria and vector control aspects of the activities are conducted in the context of malaria programme as the vectors for both diseases are mosquitoes. In order to monitor the elimination, 11 sentinel and spot-check sites have been established and baseline information has been collected. Although significant achievements have been achieved in the scale up of the LF elimination programme, there is still a need to strengthen operational research to generate programme-relevant evidence, to increase access to morbidity management services, and to improve monitoring and evaluation of the LF programme. However, the current status of implementation of the LF national programme indicates that Ethiopia is poised to achieve the 2020 goal of elimination of LF. Nevertheless, to achieve this goal, high and sustained treatment coverage and strong monitoring and evaluation of the programme are essential

Genotype Diversity of Mycobacterium bovis and Pathology of Bovine Tuberculosis in Selected Emerging Dairy Regions of Ethiopia

Bovine tuberculosis (bTB) is endemic in Ethiopia with higher prevalence in cattle, particularly in the central parts. Spread of Mycobacterium bovis (M. bovis) to wider regions is inevitable in uncontrolled conditions. This study was conducted to explore the pathology, characterize M. bovis strains, and describe genotypic diversity to demonstrate possible epidemiological links in emerging dairy areas of Ethiopia, namely, Mekelle and Gondar. Twenty-seven bTB positive cattle identified by the Single Intradermal Comparative Cervical Tuberculin (SICCT) test were subjected to post-mortem inspection to determine lesion distribution and pathological score. Samples from tissues with visible tuberculous or suspected non-visible lesions were processed and cultured following a standard protocol. Isolates identified as M. bovis by Region of Difference (RD)-based Polymerase Chain Reaction (PCR) were also spoligotyped to determine their spoligotype patterns. Post-mortem inspection of visceral organs indicated bTB suggestive lesions in 41% of the animals, with 25% being in the lungs. Lymph nodes from 77% of the animals had lesions. Fifty-five isolates identified from 24 of the slaughtered animals were confirmed as M. bovis. No other mycobacterial species were isolated. Spoligotyping classified strains from 21 of these animals into seven spoligotype patterns: SB0133, SB0134, SB1176, SB2233, SB2290, SB2467, and SB2520. More than one spoligotype were identified from five of these animals, and none of the last four spoligotypes had been reported in Ethiopia before. SB0134 was the most predominant type (47%) followed by SB0133 (25.5%). SB0133, SB2290, SB2467, and SB1176 are spoligotypes lacking spacers 3–7, characteristics of M. bovis strains of the African 2 (Af2) clonal complex, while SB0134, SB2233, and SB2520 do not belong to any of the established clonal complexes and likely to have a different evolutionary history. Despite a small sample size, the present study showed strain diversity with multiple genotypes identified in a single herd and even within a single animal, and the genotypes showed no sign of geographical localization, which could be a consequence of significant movement of bTB diseased cattle around the country, spreading the disease. Therefore, any future control programme of bTB in Ethiopia needs to address the risks of cattle movement

Epidemiology of Mycobacterium tuberculosis lineages and strain clustering within urban and peri-urban settings in Ethiopia

Background Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia. Methods Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis. Results From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]. Conclusion Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors

Weekly primaquine for radical cure of patients with Plasmodium vivax malaria and glucose-6-phosphate dehydrogenase deficiency

Background The World Health Organization recommends that primaquine should be given once weekly for 8-weeks to patients with Plasmodium vivax malaria and glucose-6-phosphate dehydrogenase (G6PD) deficiency, but data on its antirelapse efficacy and safety are limited. Methods Within the context of a multicentre, randomised clinical trial of two primaquine regimens in P. vivax malaria, patients with G6PD deficiency were excluded and enrolled into a separate 12-month observational study. They were treated with a weekly dose of 0.75 mg/kg primaquine for 8 weeks (PQ8W) plus dihydroartemisinin piperaquine (Indonesia) or chloroquine (Afghanistan, Ethiopia, Vietnam). G6PD status was diagnosed using the fluorescent spot test and confirmed by genotyping for locally prevalent G6PD variants. The risk of P. vivax recurrence following PQ8W and the consequent haematological recovery were characterized in all patients and in patients with genotypically confirmed G6PD variants, and compared with the patients enrolled in the main randomised control trial. Results Between July 2014 and November 2017, 42 male and 8 female patients were enrolled in Afghanistan (6), Ethiopia (5), Indonesia (19), and Vietnam (20). G6PD deficiency was confirmed by genotyping in 31 patients: Viangchan (14), Mediterranean (4), 357A-G (3), Canton (2), Kaiping (2), and one each for A-, Chatham, Gaohe, Ludhiana, Orissa, and Vanua Lava. Two patients had recurrent P. vivax parasitaemia (days 68 and 207). The overall 12-month cumulative risk of recurrent P. vivax malaria was 5.1% (95% CI: 1.3–18.9) and the incidence rate of recurrence was 46.8 per 1000 person-years (95% CI: 11.7–187.1). The risk of P. vivax recurrence was lower in G6PD deficient patients treated with PQ8W compared to G6PD normal patients in all treatment arms of the randomised controlled trial. Two of the 26 confirmed hemizygous males had a significant fall in haemoglobin (>5g/dl) after the first dose but were able to complete their 8 week regimen. Conclusions PQ8W was highly effective in preventing P. vivax recurrences. Whilst PQ8W was well tolerated in most patients across a range of different G6PD variants, significant falls in haemoglobin may occur after the first dose and require clinical monitoring. Trial registration This trial is registered at ClinicalTrials.gov (NCT01814683)

Network analysis of dairy cattle movement and associations with bovine tuberculosis spread and control in emerging dairy belts of Ethiopia

Background: Dairy cattle movement could be a major risk factor for the spread of bovine tuberculosis (BTB) in emerging dairy belts of Ethiopia. Dairy cattle may be moved between farms over long distances, and hence understanding the route and frequency of the movements is essential to establish the pattern of spread of BTB between farms, which could ultimately help to inform policy makers to design cost effective control strategies. The objective of this study was, therefore, to investigate the network structure of dairy cattle movement and its influence on the transmission and prevalence of BTB in three emerging areas among the Ethiopian dairy belts, namely the cities of Hawassa, Gondar and Mekelle. Methods: A questionnaire survey was conducted in 278 farms to collect data on the pattern of dairy cattle movement for the last 5 years (September 2013 to August 2018). Visualization of the network structure and analysis of the relationship between the network patterns and the prevalence of BTB in these regions were made using social network analysis. Results: The cattle movement network structure display both scale free and small world properties implying local clustering with fewer farms being highly connected, at higher risk of infection, with the potential to act as super spreaders of BTB if infected. Farms having a history of cattle movements onto the herds were more likely to be affected by BTB (OR: 2.2) compared to farms not having a link history. Euclidean distance between farms and the batch size of animals moved on were positively correlated with prevalence of BTB. On the other hand, farms having one or more outgoing cattle showed a decrease on the likelihood of BTB infection (OR = 0.57) compared to farms which maintained their cattle. Conclusion: This study showed that the patterns of cattle movement and size of animal moved between farms contributed to the potential for BTB transmission. The few farms with the bulk of transmission potential could be efficiently targeted by control measures aimed at reducing the spread of BTB. The network structure described can also provide the starting point to build and estimate dynamic transmission models for BTB, and other infectious disease