Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia

Background: Delay in treatment is also likely to be associated with a greater number of secondary cases per index case. Objective: to assess the length of patient and health system delays; and identify factors influencing these delays among pulmonary tuberculosis patients. Methods: We conducted a cross-sectional study in 13 selected government health facilities that provide both diagnostic and treatment services using Directly Observed Treatment Short course (DOTS) program. Data were collected from pulmonary TB patients aged 15 years and above during their intensive phase of DOTS treatment using a semi-structured questionnaire. Results: The median total delay was 90 days; with 28 days patient delay and 42 days health system delay. A large proportion (63%) of the overall total delay was contributed by health system delay. Patients from urban areas were 46% more likely to present to health care providers than patients from rural areas, adjusted hazard ratio (AHR) of 1.46 (95% CI: 1.10 - 1.95). Patients from urban areas were 54% more likely to be diagnosed and start treatment earlier than patients from rural areas, AHR of 1.54 (95% CI: 1.15-2.07). Female patients were more delayed to present to health providers than their male counterparts with AHR of 0.63 (95%CI: 0.47–0.84) but had shorter health system delay than male patients with AHR of 1.51 (95% CI: 1.1-22.04). Conclusion: A greater proportion of the overall total delay was contributed by health system delay. The health system should be more accessible for the unmet need. New approaches to make health services more accessible to those in greatest need (rural and women) should be designed and developed.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 148-15

ASSESSMENT OF SERVICE QUALITY OF PUBLIC AND PRIVATE BANK IN WOLAITA SODO, ETHIOPIA: A COMPARATIVE STUDY

Service quality is one of the most critical success factors that generally influence the competitiveness of a service organization. Elements of service quality differentiates a bank from its competitors . The purpose of the study is to evaluate the service quality of Commercial bank of Ethiopia (public bank) and Bank of Abyssinia (private bank) in Wolaita Sodo, Ethiopia and suggest measures for improvement in it. The study was conducted on 200 bank customers of each bank in between 15 Dec to 28 Dec 2016 in Wolaita Sodo. Descriptive research design was employed. Systematic sampling technique was used to contact the customers so that the responses can be collected from the customers. Descriptive and inferential statistics was used for analyzing the data. Findings of the research show that the service quality of customers of both the banks is on average front and satisfied category in both a public and private bank. The technical aspects and functional aspect of service quality are on satisfactory but not above average and excellent. The private bank have significant higher service quality in relation to responsiveness and assurance dimension in comparison to public bank but still that requires a lot of improvement. The research outcome recommends that both the banks should work out on all service quality dimensions viz., tangibility, reliability, responsiveness, assurance and empathy. Both the banks should work hard towards these fronts as this can give banks a competitive advantage in increasing competitive environment

Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study

Abstract Background The prevention of child mortality through immunization is one of the most cost-effective and widely applied public health interventions. In Ethiopia, the Expanded Program on Immunization (EPI) schedule is rarely completed as planned and the full immunization rate is only 24 %. The objective of this study was to identify determinant factors of incomplete childhood immunization in Arbegona district, Sidama zone, southern Ethiopia. Methods A community based unmatched case-control study was undertaken among randomly selected children aged 12 to 23 months and with a total sample size of 548 (183 cases and 365 controls). A multi-stage sampling technique was used to get representative cases and controls. Data was collected using a structured questionnaire and analyzed using SPSS version 16 statistical software. Bivariate and multiple logistic regression analyses were done to identify independent factors for incomplete immunization status of children. Qualitative data were also generated and analyzed using thematic framework. Results The incomplete immunization status of children was significantly associated with young mothers (AOR = 9.54; 95 % CI = 5.03, 18.09), being born second to fourth (AOR = 3.64; 95 % CI = 1.63, 8.14) and being born fifth or later in the family (AOR = 5.27; 95 % CI = 2.20, 12.64) as compared to being born first, a mother’s lack of knowledge about immunization benefits (AOR = 5.51; 95 % CI = 1.52, 19.94) and a mother’s negative perception of vaccine side effects (AOR = 1.92; 95 % CI = 1.01, 3.70). The qualitative finding revealed that the migration of mothers and unavailability of vaccines on appointed immunization dates were the major reasons for partial immunization of children. Conclusion To reduce the number of children with incomplete immunization status, the Arbegona district needs to consider specific planning for mothers with these risk profiles. A focus on strengthening health communication activities to raise immunization awareness and address concerns of vaccine side effects at community level is also needed. This could be achieved through integrating the immunization service to other elements of primary health care.http://deepblue.lib.umich.edu/bitstream/2027.42/116791/1/12889_2015_Article_2678.pd

Evaluation of chickpea (Cicer arietinum L.) genotypes for tolerance to Frost in controlled environment

The study aimed to evaluate the frost tolerance variability of Ethiopian chickpea (Cicer arietinum L.) germplasm under controlled environment using growth chamber. A total of 72 genotypes were screened for frost tolerance using complete randomized design with two replications. The analysis of variance result indicated that there was a significant (P<0.01) difference amongst genotypes for plant height, number of foliage, number of primary branch, growth rate, and fresh biomass weight. Based on plant survival rate (SR), 31 (43.1%) genotypes scored above 0.8 values. Based on Freezing tolerance rate (FTR), 37(51.4%) and 31(43.1%) genotypes were rated at a score of 1 to 3 in freezing test 1 (T1) and freezing test 2 (T2), respectively. There was a strong negative correlation between fresh biomass yields with SR (-0.75** for T1 and -0.71** for T2 at p<0.01), while a strong positive correlation with FTR value (0.74** at p<0.01). Based on the combined result of FTR and SR scores, 26 genotypes were found to be frost-tolerant genotypes at a temperature level as low as -5oC at seedling stage. Based on our findings, Ethiopian chickpea germplasm has a genetic potential for frost-tolerance traits for use in breeding programs

Are Healthcare Choices Predictable? The Impact of Discrete Choice Experiment Designs and Models

© 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research Background: Lack of evidence about the external validity of discrete choice experiments (DCEs) is one of the barriers that inhibit greater use of DCEs in healthcare decision making. Objectives: To determine whether the number of alternatives in a DCE choice task should reflect the actual decision context, and how complex the choice model needs to be to be able to predict real-world healthcare choices. Methods: Six DCEs were used, which varied in (1) medical condition (involving choices for influenza vaccination or colorectal cancer screening) and (2) the number of alternatives per choice task. For each medical condition, 1200 respondents were randomized to one of the DCE formats. The data were analyzed in a systematic way using random-utility-maximization choice processes. Results: Irrespective of the number of alternatives per choice task, the choice for influenza vaccination and colorectal cancer screening was correctly predicted by DCE at an aggregate level, if scale and preference heterogeneity were taken into account. At an individual level, 3 alternatives per choice task and the use of a heteroskedastic error component model plus observed preference heterogeneity seemed to be most promising (correctly predicting >93% of choices). Conclusions: Our study shows that DCEs are able to predict choices—mimicking real-world decisions—if at least scale and preference heterogeneity are taken into account. Patient characteristics (eg, numeracy, decision-making style, and general attitude for and experience with the health intervention) seem to play a crucial role. Further research is needed to determine whether this result remains in other contexts

Constitutive MAP-kinase Activation Suppresses Germline Apoptosis in NTH-1 DNA Glycosylase Deficient \u3ci\u3eC. elegans\u3c/i\u3e

Oxidation of DNA bases, an inevitable consequence of oxidative stress, requires the base excision repair (BER) pathway for repair. Caenorhabditis elegans is a well-established model to study phenotypic consequences and cellular responses to oxidative stress. To better understand how BER affects phenotypes associated with oxidative stress, we characterised the C. elegans nth-1 mutant, which lack the only DNA glycosylase dedicated to repair of oxidative DNA base damage, the NTH-1 DNA glycosylase. We show that nth-1 mutants have mitochondrial dysfunction characterised by lower mitochondrial DNA copy number, reduced mitochondrial membrane potential, and increased steady-state levels of reactive oxygen species. Consistently, nth-1 mutants express markers of chronic oxidative stress with high basal phosphorylation of MAP-kinases (MAPK) but further activation of MAPK in response to the superoxide generator paraquat is attenuated. Surprisingly, nth-1 mutants also failed to induce apoptosis in response to paraquat. The ability to induce apoptosis in response to paraquat was regained when basal MAPK activation was restored to wild type levels. In conclusion, the failure of nth-1 mutants to induce apoptosis in response to paraquat is not a direct effect of the DNA repair deficiency but an indirect consequence of the compensatory cellular stress response that includes MAPK activation

Jejunal perforation in gallstone ileus – a case series

<p>Abstract</p> <p>Introduction</p> <p>Gallstone ileus is an uncommon complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Perforation of the small intestine proximal to the obstructing gallstone is rare, and only a handful of cases have been reported. We present two cases of perforation of the jejunum in gallstone ileus, and remarkably in one case, the gallstone ileus caused perforation of a jejunal diverticulum and is to the best of our knowledge the first such case to be described.</p> <p>Case presentations</p> <p><b>Case 1</b></p> <p>A 69 year old man presented with two days of vomiting and central abdominal pain. He underwent laparotomy for small bowel obstruction and was found to have a gallstone obstructing the mid-ileum. There was a 2 mm perforation in the anti-mesenteric border of the dilated proximal jejunum. The gallstone was removed and the perforated segment of jejunum was resected.</p> <p><b>Case 2</b></p> <p>A 68 year old man presented with a four day history of vomiting and central abdominal pain. Chest and abdominal radiography were unremarkable however a subsequent CT scan of the abdomen showed aerobilia. At laparotomy his distal ileum was found to be obstructed by an impacted gallstone and there was a perforated diverticulum on the mesenteric surface of the mid-jejunum. An enterolithotomy and resection of the perforated small bowel was performed.</p> <p>Conclusion</p> <p>Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Partly due to the elderly population it affects, gallstone ileus continues to have both high morbidity and mortality rates. On reviewing the literature, the most appropriate surgical intervention remains unclear.</p> <p>Jejunal perforation in gallstone ileus is extremely rare. The cases described illustrate two quite different causes of perforation complicating gallstone ileus. In the first case, perforation was probably due to pressure necrosis caused by the gallstone. The second case was complicated by the presence of a perforated jejunal diverticulum, which was likely to have been secondary to the increased intra-luminal pressure proximal to the obstructing gallstone.</p> <p>These cases should raise awareness of the complications associated with both gallstone ileus, and small bowel diverticula.</p

Raltegravir Cerebrospinal Fluid Concentrations in HIV-1 Infection

Raltegravir is an HIV-1 integrase inhibitor currently used in treatment-experienced HIV-1-infected patients resistant to other drug classes. In order to assess its central nervous system penetration, we measured raltegravir concentrations in cerebrospinal fluid (CSF) and plasma in subjects receiving antiretroviral treatment regimens containing this drug.Raltegravir concentrations were determined by liquid chromatography tandem mass spectrometry in 25 paired CSF and plasma samples from 16 HIV-1-infected individuals. The lower limit of quantitation was 2.0 ng/ml for CSF and 10 ng/ml for plasma.Twenty-four of the 25 CSF samples had detectable raltegravir concentrations with a median raltegravir concentration of 18.4 ng/ml (range, <2.0-126.0). The median plasma raltegravir concentration was 448 ng/ml (range, 37-5180). CSF raltegravir concentrations correlated with CSF:plasma albumin ratios and CSF albumin concentrations.Approximately 50% of the CSF specimens exceeded the IC(95) levels reported to inhibit HIV-1 strains without resistance to integrase inhibitors. In addition to contributing to control of systemic HIV-1 infection, raltegravir achieves local inhibitory concentrations in CSF in most, but not all, patients. Blood-brain and blood-CSF barriers likely restrict drug entry, while enhanced permeability of these barriers enhances drug entry

Podoconiosis treatment in northern Ethiopia (GoLBet): study protocol for a randomised controlled trial

BACKGROUND Podoconiosis is one of the forgotten types of leg swelling (elephantiasis) in the tropics. Unlike the other, better-known types of leg swelling, podoconiosis is not caused by any parasite, virus or bacterium, but by an abnormal reaction to minerals found in the clay soils of some tropical highland areas. Non-governmental Organizations (NGOs) have been responsible for the development of simple treatment methods without systematic evaluation of its effectiveness. It is essential that a large scale, fully controlled, pragmatic trial of the intervention is conducted. We aim to test the hypothesis that community-based treatment of podoconiosis lymphoedema reduces the frequency of acute dermatolymphangioadenitis episodes ('acute attacks') and improves other clinical, social and economic outcomes. METHODS/DESIGN This is a pragmatic, individually randomised controlled trial. We plan to randomly allocate 680 podoconiosis patients from the East Gojjam Zone in northern Ethiopia to one of two groups: 'Standard Treatment' or 'Delayed Treatment'. Those randomised to standard treatment will receive the hygiene and foot-care intervention from May 2015 for one year, whereas those in the control arm will be followed through 2015 and be offered the intervention in 2016. The trial will be preceded by an economic context survey and a Rapid Ethical Assessment to identify optimal methods of conveying information about the trial and the approaches to obtaining informed consent preferred by the community. The primary outcome will be measured by recording patient recall and using a simple, patient-held diary that will be developed to record episodes of acute attacks. Adherence to treatment, clinical stage of disease, quality of life, disability and stigma will be considered secondary outcome measures. Other outcomes will include adverse events and economic productivity. Assessments will be made at baseline and at 3, 6, 9 and 12 months thereafter. DISCUSSION The evidence is highly likely to inform implementation of the new master plan for integrated control of Neglected Tropical Diseases (NTDs), in which podoconiosis is identified as one of eight NTDs prioritised for control. Potentially, an estimated 3 million patients in Ethiopia will therefore benefit from the results of this trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number. REGISTRATION NUMBER ISRCTN67805210 . Date of registration: 24 January 2013