Clinical performance of emergency surgical officers in southern Ethiopia

Background: Serious shortage of gynecologists and surgeons for several decades leading to a three-year masters level training was initiated in 2009. However, systematic analysis was not done to assess the graduates’ performance. The purpose of this study was to assess improvement in access to emergency surgical and obstetrical care services.Methods: Both quantitative and qualitative methods were employed to assess the competence of emergency surgical officers (ESOs) in their decision making and surgical skills in eight hospitals between 2012 and 2014. Anesthesia time, post-operative hospital stay and change in hemoglobin level were, among others, used as proxy indicators of their surgical skills.Results: A total of 4075 obstetric and surgical operations was performed in the study hospitals. Of which, 93% were done on emergency base. Of the total emergency procedures, 3570(94%) were done by ESOs. Nearly two-thirds (63%) of all the emergency operations were cesarean sections, which were done by ESOs. Out of 239 uterine ruptures, hysterectomy was done for 58%. The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs’ clinical decision making, surgical skill and commitment to discharge their responsibilities were in the best possible.Conclusions: The study showed that deployment of ESOs made the emergency surgery services accessible to the majority, and their clinical decision making and surgical skills were remarkable.Keywords: decision making, emergency surgical officer, Ethiopia, surgical skil

Elimination of Guinea Worm Disease in Ethiopia; current status of the diseases, eradication strategies and challenges to the endgame

Background: Dracunculiasis, also named Guinea Worm Disease (GWD), is one of the diseases listed under Neglected Tropical Diseases caused by a parasitic nematode known as Dracunculus medinensis. Given, its feasibility for eradication, the Guinea Worm Eradication Program (GWEP) was launched in 1980 with the aim of eradicating the disease. This paper reviews the current status of the global Guinea worm eradication in Ethiopia and intervention strategies. Methods: Published papers related to infectious diseases elimination, particularly of GWD were extracted from PubMed, WHO, CDC, and Google Scholar. Of these, the CDC website, WHO online atlas (GW data store) and recent data from EDEP were extensively used. Results: In Ethiopia, the Ethiopian EDEP which was established in 1993 has made remarkable move towards interruption of disease transmission and now the endgame is fast approaching. The EDEP with support mainly from partners has reduced GWD by more than 99% from 1994 to 2015. In 2016, 3 human cases, 14 dogs and 2 baboon infections were reported. Refugee influx from the Republic of South Sudan, increased animal infections with unknown role in transmission of Dracunculiasis, the presence of hard to reach communities and lack of safe water sources in remote non-village areas remain among important challenges at this final stage of GWD eradication in Ethiopia. Conclusion: Eradication strategies encompassing community education for behavioral change including raising awareness towards cash reward for reporting Guniea Worm Disease (GWD) and animal infection, case containment, surveillance systems, provision of safe water supply, and ABATE chemical application are discussed

Prevalence and associated factors of TB/HIV co-infection among HIV Infected patients in Amhara region, Ethiopia.

Background: Tuberculosis is one of the world\u2019s most common causes of death in the era of Human immunodeficiency virus. The purpose of this study was to determine the prevalence and associated factors of TB/HIV co-infection. Methods: Hospital based retrospective studies were conducted among adult HIV-positive patients. Logistic regression method and Chi square test were applied. Results: A total of 571 HIV positive study participants were enrolled. Of these, 158 (27.7%) were found to have pulmonary tuberculosis. Lower baseline CD4 count<200cell/\u3bcl, patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients whose marital status was single were significant predictors for increased risk of tuberculosis in PLWHIV (P <0.05). Non smoker patients, patients in WHO clinical stage I, patients in WHO clinical stage II and ownership of the house had significant protective benefit against risk of TB (P <0.05). Conclusion: The prevalence of TB/HIV co-infection in adults on ART in our study was moderately high. Having advanced clinical status and presence of risk factors were found to be the predicting factors for co-infection. The health office should open TB/HIV co-infection units in the hospitals and health workers should be cautious when a patient has an advanced disease

Genetic Variability and Relationship of Camel (Camelus dromedarius) Populations in Ethiopia as Evidenced by Microsatellites Analysis

AbstractThis study was carried out to assess the genetic diversities and population structure of six camel populations of Ethiopia. Blood samples were collected from 114 camels (17-24 per population) and genotyped using10 camel microsatellite marker loci. The result revealed high genetic diversities in Ethiopian camel populations with average observed and expected heterozygosity, total number of alleles (TNA), mean number of alleles (MNA) and effective number of alleles of 0.55, 0.73,153, 6.8 (0.36) and 4.47(0.23), respectively. Among the 52 private alleles in the six Ethiopian camel populations, 31 of them were occurring at a frequency of ≥5%. It was also found that most of the variations in Ethiopian camels were attributed to within population variation (92%) while 8% was explained by between populations variation. Even though there was high heterozygosity, high inbreeding coefficient was detected in Ethiopian camel populations. From the sex camel populations 34.1, 33.4 and 28.6% alleles of Gelleb, Amibara and Liben camel populations respectively affected by inbreeding. The between population differentiation was (FST=0.11(0.01) indicating moderate population differentiation. The neighbor-joining tree and structure analysis show that the Ethiopian camel populations were clustered into four subgroups. The Afar camels were grouped into two together with the Ethiopian Somali camels (Jigjiga with Mille and Gelleb with Amibara) and the two Ogaden camels (Liben and Hoor) are separated into two subgroups indicating that some of the Afar and the Somali camels were admixed. Therefore, even though high hetrozygosity within population and moderate genetic differentiation between populations were observed, the presence of high inbreeding coefficient may affect hetrozygosity in the overall populations

The usefulness of school-based syndromic surveillance for detecting malaria epidemics: experiences from a pilot project in Ethiopia.

BACKGROUND: Syndromic surveillance is a supplementary approach to routine surveillance, using pre-diagnostic and non-clinical surrogate data to identify possible infectious disease outbreaks. To date, syndromic surveillance has primarily been used in high-income countries for diseases such as influenza--however, the approach may also be relevant to resource-poor settings. This study investigated the potential for monitoring school absenteeism and febrile illness, as part of a school-based surveillance system to identify localised malaria epidemics in Ethiopia. METHODS: Repeated cross-sectional school- and community-based surveys were conducted in six epidemic-prone districts in southern Ethiopia during the 2012 minor malaria transmission season to characterise prospective surrogate and syndromic indicators of malaria burden. Changes in these indicators over the transmission season were compared to standard indicators of malaria (clinical and confirmed cases) at proximal health facilities. Subsequently, two pilot surveillance systems were implemented, each at ten sites throughout the peak transmission season. Indicators piloted were school attendance recorded by teachers, or child-reported recent absenteeism from school and reported febrile illness. RESULTS: Lack of seasonal increase in malaria burden limited the ability to evaluate sensitivity of the piloted syndromic surveillance systems compared to existing surveillance at health facilities. Weekly absenteeism was easily calculated by school staff using existing attendance registers, while syndromic indicators were more challenging to collect weekly from schoolchildren. In this setting, enrolment of school-aged children was found to be low, at 54%. Non-enrolment was associated with low household wealth, lack of parental education, household size, and distance from school. CONCLUSIONS: School absenteeism is a plausible simple indicator of unusual health events within a community, such as malaria epidemics, but the sensitivity of an absenteeism-based surveillance system to detect epidemics could not be rigorously evaluated in this study. Further piloting during a demonstrated increase in malaria transmission within a community is recommended

Can Interferon-Gamma or Interferon-Gamma-Induced-Protein-10 Differentiate Tuberculosis Infection and Disease in Children of High Endemic Areas?

Diagnosis of childhood tuberculosis (TB) is difficult in high TB burden settings. Interferon-gamma-induced protein 10 (IP10) has been suggested as a marker of TB infection and disease, but its ability to differentiate the two conditions remains uncertain.To describe Interferon-gamma (INFγ) and IP10 expression in children with TB infection and disease and controls to assess their potential to differentiate latent and active TB. TB), 335 children in contact with adults with pulmonary TB and 156 community controls in Southern Ethiopia. The Tuberculin Skin Test (TST) and Quantiferon-In-Tube (QFT-IT) were performed. INFγ and IP10 were measured in plasma supernatants.INFγ and IP10 can identify children with TB infection and disease, but cannot differentiate between the two conditions. HIV status did not affect the expression of IP10

Optimization of community-based breeding programs

Any breeding program undergoes numerous stages of improvement and adjustment and is never completely flawless from the beginning. Initial selection in the community-based breeding programs (CBBPs) were made only based on phenotypic performance, disregarding the relationships between individuals. Following the accumulation of pedigree and performance data, the BLUP animal model has now been employed. Significant genetic gain for selection qualities were achieved in Ethiopian sheep CBBPs. However, there are still ways to maximize genetic advancement and overall advantages of the breeding programs. A method to maximize the current CBBPs was studied, which included increasing selection intensity and sire use strategy, index-based selection, enhancing breeding females' reproductive productivity, and connecting CBBPs with the production unit. The researchers attended planning and training sessions regarding CBBP optimization. The researchers later returned to their respective villages and implemented CBBP optimization as appropriate

The Reproductive Platform to Deliver Genetic Gain in Sheep and Goats

The Reproductive Platform to Deliver Genetic Gain in Sheep and Goats presentation

Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018−2020

PURPOSE: Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation—follicular (TF) prevalence in 1–9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. METHOD: We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. RESULT: Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1−9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. CONCLUSION: Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these

Prevalence of Trachoma after Implementation of Trachoma Elimination Interventions in Oromia Regional State, Ethiopia: Results of Impact Surveys in 131 Evaluation Units Covering 139 Districts

PURPOSE: To determine the prevalence of trachomatous inflammation—follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. METHODOLOGY: A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. RESULTS: A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1–9 years ranged from 0.15% (95% confidence interval [CI]: 0.0–0.4) to 37.5% (95% CI: 31.1–43.7). The TF prevalence was <5% in 73/131 (56%) EUs. The EU-level age- and gender-adjusted prevalence of TT unknown to the health system among people aged ≥15 years ranged from 0.001% (95% CI: 0.00–0.02) to 2.2% (95% CI: 1.1–3.1) with 37/131 (28%) EUs having a prevalence <0.2%. Only 48% of all households surveyed had access to improved water sources for drinking. Approximately 96% of households did not have an improved latrine. CONCLUSION: Oromia is on the path towards elimination of trachoma as a public health problem