Use integrated management of childhood illnesses guidelines: a need for adaptation for use in Ghindae hospital, Eritrea

Background: Diarrheal diseases are among the commonest causes of morbidity and mortality among infants and young children in the developing world and most commonly in the sub-Saharan including Eritrea. Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by UNICEF and WHO for developing countries and other resource poor countries currently being practiced in Africa, Asia, and South America. IMCI guidelines are simplified system of diagnosis and treatment that is designed for use by health workers with limited training and little or no laboratory support. According to this guideline bloody diarrhea is treated with ORS, additional fluid support and cotrimoxazole empirically with the assumption that the etiologic agent is shigella. If the child does not improve on follow up then metronidazole is added with the assumption that the etiologic agent is parasitic mainly amoeba and giardia. Objective: The objective of this study was to assess the use of IMCI guidelines in children presenting with diarrhea at Ghindae Hospital. Methods: The study was a prospective in which all children below the age of 5 years, who presented primarily with all forms of diarrhea during the one month period from June 1st 2008 to June 30 2008, were included in the study. All stool samples were subjected to laboratory analysis. Results: Eighty seven children who presented with all forms of diarrhea to the IMCI OPD or as IPD were included in the study. More than 50% of the cases had parasitic infestation mainly Amoeba and Giardia. Less than 5% of the children presented with mild or severe dehydration. The majority (92%) of the cases had no dehydration had diarrhea with no dehydration. Conclusion: In Ghindae community there is a justification for use of metronidazole as a first line treatment of bloody diarrhea, because of the preponderance of parasitic infestation instead of bacterial causes for the majority of cases of children presenting with diarrhea, a clear need for adaptation of IMC

The quality of water served in the Orotta National Referral Hospital

Background: The principal risks to human health associated with the consumption of unsafe drinking water are microbiological. According to the WHO and UNICEF report 2.6 billion people do not have access to good quality of water. About 1.1 billion people globally do not have access. About 2 million people mostly of less than 5 years children also die as a result of diarrheal diseases related to consumption of water that is microbiologically contaminated. Objective: The objective of this study was to measure the quality of water served to the different sections of Orotta National Referral Hospital using WHO protocols. Methods: Water samples were collected from different sources in the National Referral Orotta Hospital compound according to the WHO guidelines and the multi-tube method or most probable number method was used for the microbiological count. Results: The findings from the study showed that some of the samples of water from National Referral Pediatric Hospital, and National Medical and Surgical Referral Hospital reservoirs did not meet some of the WHO guidelines for safe drinking water. Conclusion and recommendations: The water contamination emanated from the reservoirs of the Orotta Hospital, because the samples taken as a control from outside the Hospital compound were free of contamination. Water reservoirs should be washed on regular basis. Chlorination and other treatment modalities for the water in the reservoir should also be considered and applied. Water quality surveillance should be done several times in a year not only just once

Effectiveness of the new water source intervention in reducing diarrheal diseases in Ghindae community, Eritrea

Background: Diarrheal diseases are an important cause of morbidity and mortality in developing countries particularly in children. In Ghindae, a town 45 km from Asmara the capital city of Eritrea, diarrheal diseases were the commonest disease among all age groups. Based on findings from operational research, the old water supply of the town was believed to be the main source of the disease. A new water supply system was built for the community. Objective: The objective of this study was to evaluate the effectiveness of the new water supply system intervention in reducing diarrheal diseases in Ghindae community. Methods: Retrospective study was done base on the records of the Hospital. Results: The incidence of diarrhea decreased by 15% after the introduction of a new water distribution system. The decrease was 44% for giardiasis and 25% for amoebiasis. There was no change in the bloody diarrhea disease burden. Conclusion: The incidence of diarrhea was still unacceptably high in spite of the revamping of the water system, an observation which calls upon other contributory factors such as point use contamination and socio-economic status

Recent lessons learnt from the outbreak of brucellosis in Dekemhare, Anseba, Eritrea

Brucellosis is an acute to chronic zoonotic disease which is endemic in some tropical developing countries with profound impact on infected animals and people. The study examined some of the risk factors for brucellosis following outbreak of the disease in Anseba, a region in Eritrea. Twenty three patients from Dekemhare, 2 of whom were admitted with confirmed diagnosis of brucellosis in Orotta National Referral Medical and Surgical Hospital in Asmara while the other 21, two thirds of whom confirmed positive for brucellosis according to the Rose Bengal slide agglutination test, sought services in local health facilities in Dekemhare following an outbreak of the disease in May 2008. More than 80% of the patients mostly students, consumed un-boiled milk. Two thirds of the animals in the area were sick but less than 20% received veterinary consultations with half of them testing positive for brucellosis. This report links contraction of brucellosis to human through contact with infected animals and drinking of un-boiled milk. Appropriate health promotion focusing on young people and targeting preventive measures such as regular use of veterinary services and consumption of boiled milk complemented by monitoring of brucellosis through integrated disease surveillance and response in Eritrea may cost effectively prevent brucellosis.Key words: PMTCT, LQAS Keywords: Zoonosis, brucellosis, Eritrea, veterinary service

How effects on health equity are assessed in systematic reviews of interventions.

BACKGROUND: Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions.  OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS: We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA: We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.  MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS: There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness