Referral of Surgical Patients Abroad: A 5-years Review from a Tertiary Teaching Hospital in Addis Ababa Ethiopia

Background: The general objective of this review was to determine the reasons for referral abroad of surgical patients at Addis Ababa University Medical Faculty, Tikur Anbassa HospitalMethods: The referral slips of patients who were referred abroad from September 2005 – August 2009 by surgical Department were collected and reviewed.Results: The study reviewed a total of 331 patents in the 5 year period mentioned. An average of 66 patients was referred per year. There was an over all male preponderance 183(55.3 %), majority of patients were in the age group 26 - 50 years (173).Most were residents from the Capital, 232 (70 %). Neoplastic diseases both benign and malignant account for 155 cases. Primary brain tumors either malignant or benign account for 74 cases. 97 of the cases had at least one surgical intervention done prior to referral. The overall trend is showing some decrement. The main reason for referral was for better surgical intervention (249). Referral for MRI which accounted for 16 of the referrals in the first 2 years was virtually non existent in the next 3 years.Conclusion: Most cases were form the capital, Neurosurgical cases have been referred more than any other subspecialties, neoplastic changes constitute the main reason for referral, and the overall trend seems decreasing along the course

Climate Change and Variability: Implications for Household Food Security in Agro-pastoral Areas of Jigjiga District, Eastern Ethiopia

Ethiopia is one of the most vulnerable countries of the world to the impacts of climate change and variability. The impact is even stronger in pastoral areas of the country. However, studies on the actual climate change dynamics and its effect on food security at local and household levels are limited. The present study took Jigjiga district as a case and analyzed changes in local climate; status of household food security; the relative significance of climate related causes of food insecurity; and household level determinants of food security. The study used rainfall and temperature data from the period 1952 to 2010 and primary data gathered from 140 sample households and focus group discussions. Using Mann-Kendall trend test, the study revealed the existence of statistically significant declining trend in rainfall in the rainy season and increasing trend in temperature at annual and seasonal time scale. Moreover, respondents confirmed the presence of climate change, with increasing temperature, decreasing rainfall amount and increasing seasonality of rainfall in the past two decades. The Rash model estimation result based on the Food Security Core Module showed high prevalence of food insecurity in the district with 81 per cent of food insecure households consisting of 27 per cent food insecure without hunger, 29 per cent food insecure with moderate hunger, and 25 per cent food insecure with severe hunger. Respondents ranked climate factors as their top most important causes of food insecurity. These are drought, low annual rainfall, high temperature, and water shortage. The econometric model estimation result revealed the important factors determining household food security. These are household perception of climate change, use of soil and water conservation practices, use of livestock feed management techniques, loss of livestock due to drought and/or disease, literacy level of household head, and dependency ratio. Among other things, the study suggested improving climate change awareness and strengthening the existing adaptation measures that have positive impacts on food security.Keywords: climate change, climate variability, adaptation measures, food security, agro-pastoralism

Participatory smallholder dairy value chain development in Fogera woreda, Ethiopia: Experiences from IPMS project interventions

Market-oriented smallholder dairy in Fogera has an opportunity for growth because of growing urban population in the district itself as well as in the wider Bahr Dar–Gondar milkshed. IPMS in 2005 introduced a participatory market-oriented dairy value chain development approach with partner organizations. IPMS together with its partners also identified gaps in the dairy value chain through Participatory Rapid Appraisal (PRA) and also designed interventions involving key value chain actors. This approach included increased use of knowledge capturing and sharing by the extension services. Major production interventions were the development of communal grazing areas through clearance of noxious weed called Hygrophilla auriculata and introduction of area enclosure, backyard fodder development and increased use of rice crop residues. Input service supply interventions included community-based trypanosomosis control and bulls stations. IPMS and its partners also provided the required support for establishment of two milk processing marketing cooperatives. Communal grazing area development is now practised in 16 villages (PAs) and harvested biomass production was estimated at 7 to 11 t of DM/year. As a result of the cut-and-carry system, the proportion of legumes increased, thus improving its nutritive value. The increased availability of the rice straw and bran resulting from rice value chain development in Fogera has also impacted dairy production. Urea treatments of rice straw as well as supplementary feeding with rice bran were demonstrated in 13 PAs. An on-farm experiment conducted by an MSc student indicated doubling of daily milk yields. However, use of straw could be increased further if urea for the treatment of straw could be made available in the dry season. Trypanosomosis control introduced in infested areas has significantly reduced the number of infected animals and the program is now institutionalized by regional, district and NGO partners. The introduction of bull stations resulted in increased number of improved Fogera breed cows and crossbreed with Holstein-Frisians. However, the number of improved dairy cows is still low and the District should consider the recently introduced mass insemination approach with the help of hormones. Marketing and processing of milk in urban and peri-urban areas through formation of small cooperatives has started; however, impact is still limited due to lack of business orientation, and alternative marketing outlets for individual producers. While some linkages were made with the larger Bahr Dar milkshed, more attention needs to be paid to this market once milk production increases. A household survey conducted in 2009, which assessed the combined impact of all interventions, showed significant differences in milk quantities sold by adopter and non-adopter households in the urban areas and doubling of butter production/sales in the rural areas. It is noted that this additional butter sales benefits rural women since they manage the production and sale of butter

Prevalence of Metabolic Syndrome among Working Adults in Ethiopia

Objective. To evaluate the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and Adult Treatment Panel (ATP) III criteria among working East African adults. Design. This cross-sectional study of 1,935 individuals (1,171 men and 764 women) was conducted among working adults in Addis Ababa, Ethiopia. The study was conducted in accordance with the STEPwise approach of the World Health Organization. Results. According to ATP III and IDF definitions, the overall prevalence of MetS was 12.5% and 17.9%, respectively. Using ATP III criteria, the prevalence of MetS was 10.0% in men and 16.2% in women. Application of the IDF criteria resulted in a MetS prevalence of 14.0% in men and 24.0% in women. The most common MetS components among women were reduced high-density lipoprotein-cholesterol (HDL-C) (23.2%) and abdominal obesity (19.6%); whilst reduced HDL-C concentrations (23.4%) and high blood pressure (21.8%) were most common among men. Conclusion. MetS and its individual components are prevalent among an apparently healthy working population in Ethiopia. These findings indicate the need for evidence-based health promotion and disease prevention programs; and more robust efforts directed towards the screening, diagnosis and management of MetS and its components among Ethiopian adults

Visceral leishmaniasis patients display altered composition and maturity of neutrophils as well as impaired neutrophil effector functions

Immunologically, active visceral leishmaniasis (VL) is characterised by profound immunosuppression, severe systemic inflammatory responses and an impaired capacity to control parasite replication. Neutrophils are highly versatile cells, which play a crucial role in the induction as well as the resolution of inflammation, the control of pathogen replication and the regulation of immune responses. Neutrophil functions have been investigated in human cutaneous leishmaniasis, however, their role in human visceral leishmaniasis is poorly understood. In the present study we evaluated the activation status and effector functions of neutrophils in patients with active VL and after successful anti-leishmanial treatment. Our results show that neutrophils are highly activated and have degranulated; high levels of arginase, myeloperoxidase and elastase, all contained in neutrophils’ granules, were found in the plasma of VL patients. In addition, we show that a large proportion of these cells are immature. We also analysed effector functions of neutrophils that are essential for pathogen clearance and show that neutrophils have an impaired capacity to release neutrophil extracellular traps, produce reactive oxygen species and phagocytose bacterial particles, but not Leishmania parasites. Our results suggest that impaired effector functions, increased activation and immaturity of neutrophils play a key role in the pathogenesis of VL

Wind direction data from a coastal HF radar system in the gulf of naples (central mediterranean sea)

Results on the accuracy of SeaSonde High Frequency (HF) radar wind direction measurements in the Gulf of Naples (Southern Tyrrhenian Sea, Central Mediterranean Sea) are here presented. The investigation was carried out for a winter period (2 February-6 March) and for one summer month (August) of the reference year 2009. HF radar measurements were compared with in situ recordings from a weather station and with model data, with the aim of resolving both small scale and large scale dynamics. The analysis of the overall performance of the HF radar system in the Gulf of Naples shows that the data are reliable when the wind speed exceeds a 5 m/s threshold. Despite such a limitation, this study confirms the potentialities of these systems as monitoring platforms in coastal areas and suggests further efforts towards their improvement

Long-term fire resilience of the Ericaceous Belt, Bale Mountains, Ethiopia

Fire is the most frequent disturbance in the Ericaceous Belt (ca 3000- 4300 m.a.s.l.), one of the most important plant communities of tropical African mountains. Through resprouting after fire, Erica establishes a positive fire feedback under certain burning regimes. However, present-day human activity in the Bale Mountains of Ethiopia includes fire and grazing systems that may have a negative impact on the resilience of the ericaceous ecosystem. Current knowledge of Erica-fire relationships is based on studies of modern vegetation, lacking a longer time perspective that can shed light on baseline conditions for the fire feedback. We hypothesize that fire has influenced Erica communities in the Bale Mountains at millennial timescales. To test this, we (1) identify the fire history of the Bale Mountains through a pollen and charcoal record from Garba Guracha, a lake at 3950 m.a.s.l., and (2) describe the long-term bidirectional feedback between wildfire and Erica, which may control the ecosystem's resilience. Our results support fire occurrence in the area since ca 14 000 years ago, with particularly intense burning during the early Holocene, 10.8-6.0 cal ka BP. We show that a positive feedback between Erica abundance and fire occurrence was in operation throughout the Lateglacial and Holocene, and interpret the Ericaceous Belt of the Ethiopian mountains as a long-term fire resilient ecosystem. We propose that controlled burning should be an integral part of landscape management in the Bale Mountains National Park