Striking a balance in the need for upholding basic principles of international humanitarian law in the fight against terrorism

Following the 9/11 attack, the world entered into a global fight against terrorist organizations and state sponsoring terrorism. The fight has started in 2001 in Afghanistan against Al-Qaeda and the Taliban and later extended to Iraq in 2003. However, the creation of the Islamic State (ISIS) and other terrorist organizations shifted both terrorism and the fight against terrorism to a different level. As a result, the world is under the Global Fight against International Terrorism (GFIT). The GFIT has posed so many problems in the application of the rules of International Humanitarian Law (IHL). Therefore, this article, doctrinally, discusses the changes and analyzing them according to the rules of IHL. Accordingly, the violations of the basic principles of IHL will be discussed. Keywords: Global Fight against International Terrorism (GFIT), Military Necessity, Humanity, Distinction, International Humanitarian Law (IHL)

Prevalence of musculoskeletal pain and factors associated with kyphosis among pedestrian back-loading women in selected towns of Bench Maji zone, Southwest Ethiopia

Background: In developing countries including Ethiopia, it is common to see women carrying heavy loads on their back. Musculoskeletal pain and deformities are expected to be higher when there is heavy physical work. Many women lead their lives by selling heavy fire woods to residents in urban areas by back loading. This may have an impact on musculoskeletal health.Objective: The main objective of this study was to assess prevalence of musculoskeletal pain and factors associated with kyphosis among pedestrian back-loading women in Bench-Maji zone.Methods: The study was conducted in Bench Maji zone, Southwest Ethiopia from January to March 2016. Cross-sectional study design was employed. The sample size was calculated to be 422. Four towns found in the zone were selected to identify women who sell fire woods by carrying it on their back. Women were selected by using convenience sampling technique. Standardized questionnaire was used to collect data on musculoskeletal pain. Checklist was used to diagnose kyphosis. Cleaned and coded data was entered in to Epidata 3.1 and exported to SPSS version 20 for analysis. Binary logistic regression was used to identify factors associated with kyphosis.Results: Among 422 participants who were involved in this study 173(41%) were in the age range of 19-34 years. In this study, majority 340(80.6%) of the study participants were protestants. Regarding the educational status, majority 339(80.3%) of the participants were unable to read and write. Majority of the study participants were from Mizan town (50.2%). Regarding musculoskeletal pain, this study indicated that the prevalence of upper back pain, lower back pain, shoulder pain, elbow pain, wrist pain, knee pain and feet pain were 67.3%, 60.4%, 68.2%, 47.2%, 36.7%, 46.9% and 44.1% respectively. The prevalence of kyphosis was 59.7%. The odds of kyphosis was higher among age greater than 40 years (AOR= 1.91: 95% CI 1.03, 3.54) and those worked for more than 10 years (AOR= 2.15: 95% CI 1.01, 4.61) than their counter parts. Town where they come to sell fire wood was also significantly associated with kyphosis.Conclusion: The prevalence of musculoskeletal pain was high. Age, town and duration of work were significantly associated with kyphosis. Thus, it needs attention from concerned bodies. [Ethiop. J. Health Dev. 2017;31(2):103-109]Keywords: Musculoskeletal pain, Kyphosis, Back loading, Ethiopi

Incidence and Predictors of Tuberculosis Among Adult PLWHA at Public Health Facilities of Hawassa City

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important

Study on the status of bovine tick infestation, in Guba-koricha District in West Hararghe zone, east - Ethiopia

Abstract A cross-sectional study was conducted from November 2010 to April 2011 to determining the prevalence of tick infestation, to identify the common tick species in cattle andto assess the major risk factors associated with the occurrence of tick species in Gubakorichadistrict WestHararghe zone of Oromia regional state, southeast Ethiopia.Ticks were collected by searching and half body of animals using forceps on different regions of the animals’ body. A total sample of 384 cattle, 234 were found to be infested by one or more tick species an overall prevalence of 60.9%. The most predominant isolated ticks species in this study were R.pullchelus with isolation rate of 49.4% followed A. Varigatum with isolation rate of 30.3%, H. marginatumrufipes, the third predominant with isolation rate 11.8%. However, A. gemma, H. trucatum and R. Evertsi-evertsi was the least isolate which accounts for 3.6%, 2.4% and 2.35% respectively.Age, sex and body conditions scoring were found to be important risk factors associated with tick infestation. The prevalence of tickinfestation between age and sex was statistically significant (X2=32.3075, CI=0.1323358-0265075, P=0.000 andX2=5.117, CI=0.1953184-0.0061713, P=0.037) respectively. However, breed and body condition were not statistically significant (P>0.05). Hereof, Ticks are obligate, blood feeding ecto-parasites that cause severe damage to the hides and skins of domestic cattle due to this reduce the foreign exchange of the country; and also transmit tick borne diseases. Therefore, effective tick control programs should be formulated and implemented at national or regional level

Barriers to Males Involvement in Family Planning Services in Arba Minch Town, Southern Ethiopia: Qualitative Case Study

Effective utilization of family planning services are major contributors of improved maternal health. This, in turn, needs adequate involvement of male partners through direct uptake the services and approval of the spouses’ usage. Yet the family planning method utilization as well as male involvement is indicated to be low in Ethiopia. Qualitative case study was conducted in August 2015 in Arba Minch town to identify barriers to male involvement in uptake of family planning services. Open ended, semi-structured questionnaire was used to interview the participants. Four men and four women are purposively selected. Interviews were conducted in audibly private location after verbal consent was obtained from the recruited individuals. All interviews were recorded and transcribed verbatim. The narratives were then translated to English and the responses are aggregated in to nine concepts. The final aggregated data were analyzed using OpenCode 3.4 software based on thematic framework analysis. Total of eight participants (four men and four women) were interviewed where seven are married and one is single. Participants identified that, Perception (or opinion) towards family planning as women’s issue, Sex preference for inheritance and considering children as measure of blessing of and Fear of partner sexual promiscuity and to reduce women’s attractiveness were barriers for male involvement in modern family  planning method. Future interventions aimed at improving family planning services and methods utilization in Arba Minch town and similar settings need to consider these bottlenecks for male involvement

STUDY ON THE STATUS OF BOVINE TICK INFESTATION, IN GUBAKORICHA DISTRICT IN WEST HARARGHE ZONE, EAST - ETHIOPIA

A cross-sectional study was conducted from November 2010 to April 2011 to determining the prevalence of tick infestation, to identify the common tick species in cattle and to assess the major risk factors associated with the occurrence of tick species in Guba koricha district West Hararghe zone of Oromia regional state, southeast Ethiopia. Ticks were collected by searching and half body of animals using forceps on different regions of the animals’ body. A total sample of 384 cattle, 234 were found to be infested by one or more tick species an overall prevalence of 60.9%. The most predominant isolated ticks species in this study were R. pullchelus with isolation rate of 49.4% followed A. Varigatum with isolation rate of 30.3%, H. marginatum rufipes, the third predominant with isolation rate 11.8%. However, A. gemma, H. trucatum and R. Evertsi-evertsi was the least isolate which accounts for 3.6%, 2.4% and 2.35% respectively. Age, sex and body conditions scoring were found to be important risk factors associated with tick infestation. The prevalence of tick infestation between age and sex was statistically significant (X2=32.3075, CI=0.1323358-0265075, P=0.000 andX2=5.117, CI=0.1953184- 0.0061713, P=0.037) respectively. However, breed and body condition were not statistically significant (P>0.05). Hereof, Ticks are obligate, blood feeding ecto-parasites that cause severe damage to the hides and skins of domestic cattle due to this reduce the foreign exchange of the country; and transmit tick borne diseases. Therefore, effective tick control programs should be formulated and implemented at national or regional level

Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950.Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950