Status of Schistosoma mansoni prevalence and intensity of infection in geographically apart endemic localities of Ethiopia: A comparison

BACKGROUND: Schistosomiasis is one of the chronic and neglected tropical diseases affecting rural communities. Heavy infections contribute to anemia and can retard children's growth, physical activity and cognitive function. This study was conducted in order to determine the prevalence, intensity and variation of Schistosoma mansoni infection among human subjects in geographically apart localities. The prevalence and intensity of Schistosoma mansoni infection was assessed in three geographically apart endemic areas of Ethiopia from May to August 2010 through cross-sectional approach.METHODS: A total of 1073 individuals (528 males and 545 females) were found eligible for the study. Their age ranged from 5-60 years with mean age of 11 years in Wondo Genet, 22 years in Kemissie and 24 years in Sille-Elgo. Small plastic sheets were distributed to the study participants and sizable stool specimens were collected and examined using Kato-Katz method (41.7mg template).RESULT: The prevalence of Schistosoma mansoni infection among the study participants in Kemissie, Wondo Genet and Sille-Elgo was 89.6%, 59.9%, and 31.6%, respectively. The highest geometric mean of egg per gram of stool for Kemissie, Wondo Genet and Sille-Elgo was, 5208 and 346, 8472 and 252, 3960 and 91, respectively.CONCLUSION: It was observed that there was comparable variation in the prevalence and intensity of infection among the study localities. Moreover, it is indicated that S. mansoni is still an ongoing public health problem which requires integrated intervention activities in the country.KEYWORDS: Schistosoma mansoni; intensity of infection; geographic variation; Ethiopi

Concurrent Infection of Hydatidosis and Fasciolosis in Cattle Slaughtered at Mekelle Municipal Abattoir, Tigray Region

An abattoir survey was carried out in Mekelle municipal abattoir, Ethiopia to determine the prevalence of concurrent infections of hydatidosis and fasciolosis in cattle. A total of 4,481 slaughtered cattle were studied by ante- and post-mortem examinations. From the total 4,481 slaughtered cattle examined at Mekelle municipality abattoir, 357 (8%) were found to harbor mixed infection of hydatidosis and fasciolosis. While the individual prevalence of hydatidosis and fasciolosis was 32.11% and 24.32%, respectively. Multivariate logistic regression analysis indicated that among the factors considered in the current study, origin of animals had statistically significant ffect on the prevalence of concurrent infection (OR = 1.418, 95% CI = 1.108 - 1.814, p = 0.005), whereas breed and body condition of animals didn’t have significant effect on prevalence of the co-infection. Moreover, month had no statistically significant effect on prevalence of hydatidosis and fasciolosis co-infection (OR= 1.0029, 95% CI = 0.9758 - 1.0306, p = 0.867). Generally this study showed that hydatidosis and fasciolosis are important disease problems in cattle in the study area. The relatively higher prevalence in the occurrence of the concurrent infection of hydatidosis and fasciolosis in this study may suggest that ecological factors that determine the occurrence of the two diseases might be similar. On the other hand, the higher prevalence of the individual or concurrent infection may imply that these diseases have the potential to cause considerable economic and public health problems. Keywords: Coinfection, Fasciolosis, Hydatidosis, Mekelle, Prevalence

Schistosoma mansoni Infection in Finchaa Sugar Estate: Public health Problem Assessment based on Clinical Records and Parasitological Surveys, Western Ethiopia

The survey of Schistosoma mansoni (S. mansoni) in Finchaa Sugar Estate, Western Ethiopia, was conducted to investigate the prevalence and health problems of schistosomiasis with some of the risk factors. The examination was undertaken based on the analysis of retrospective clinical data from the health center and a cross-sectional parasitological examinations using Kato-thick smear slides in April-June 2012/2013. Over the period 2008 to 2013 average prevalence among suspected patients at the health centre was 30.9%. Examination of double kato-thick smear slides from a random sample of 602 individuals from most schistosomiasis affected camp 7 revealed the prevalence of 37.5%. S. mansoni infection is become a year-round public health problem in Finchaa, Sugar Estate possibly due to permanent streams, water bodies and water contact behaviors and also reduced effectiveness of current control measures. Among the 7th camps, village A (camp 7) is the most schistosomiasis affected area (37.5%) followed by Kuyisa (25%). This is attributed to the presence of permanent stream (Fekerie stream) near camp 7. The present finding shows that the prevalence and intensity of schistosomiasis in the more affected camp 7 of Finchaa Sugar Estate was significantly higher among males than in females and its prevalence and intensity was found to be higher among study population within the age group of 11-20 years old. This study indicates that schistosomiasis is a major health problem in Finchaa Sugar Estate with moderate prevalence. The study results will provide an additional clinical and parasitological data on the current status of S. mansoni in Finchaa Sugar Estate and could serve as a guide in designing, developing and implementing intervention strategies to mitigate morbidity due to S. mansoni especially in highly risk groups under the Ethiopian health service system.Keywords: Egg per gram; Finchaa Sugar Estate; Kato-katz; Schistosomiasis; S. mansoni; Public healt

Weight gain after smoking cessation and risk of major chronic diseases and mortality

Importance: Smoking cessation is frequently followed by weight gain; however, whether weight gain after quitting reduces the health benefits of quitting is unclear. Objective: To examine the association between weight change after smoking cessation and the risk of cardiovascular diseases (CVD), type 2 diabetes, cancer, chronic obstructive pulmonary disease (COPD), and all-cause mortality. Design, Setting, and Participants: This cohort study analyzed data from a nationally representative sample of Australian adults aged 18 years or older who were studied between 2006 and 2014. Smoking status and anthropometric measurements were self-reported annually. Cox proportional hazards regressions were used to determine the hazard ratios (HRs) for the association between changes in weight and body mass index (BMI) and the risk of CVD, type 2 diabetes, cancer, COPD, and mortality. Data were analyzed in January 2019. Exposures: Annual self-reported smoking status; years since quitting. Main Outcomes and Measures: Weight gain after quitting, incident CVD, type 2 diabetes, cancer, COPD, and all-cause mortality. Results: Of a total 16663 participants (8082 men and 8581 women; mean [SD] age, 43.7 [16.3] years), those who quit smoking had greater increases in weight (mean difference [MD], 3.14 kg; 95% CI, 1.39-4.87) and BMI (MD, 0.82; 95% CI, 0.21-1.44) than continuing smokers. Compared with continuing smokers, the HRs for death were 0.50 (95% CI, 0.36-0.68) among quitters who lost weight, 0.79 (95% CI, 0.51-0.98) among quitters without weight change, 0.33 (95% CI, 0.21-0.51) among quitters who gained 0.1 to 5.0 kg, 0.24 (95% CI, 0.11-0.53) among quitters who gained 5.1 to 10 kg, and 0.36 (95% CI, 0.16-0.82) among quitters who gained more than 10 kg. The HRs for death were 0.61 (95% CI, 0.45-0.83) among quitters who lost BMI, 0.86 (95% CI, 0.51-1.44) among quitters without change in BMI, 0.32 (95% CI, 0.21-0.50) among quitters who gained up to 2 in BMI, and 0.26 (95% CI, 0.16-0.45) among quitters who gained more than 2 in BMI. Conclusions and Relevance: This cohort study found that smoking cessation was accompanied by a substantial weight gain; however, this was not associated with an increased risk of chronic diseases or an attenuation of the mortality benefit of cessation

Governments' policy response to drought in Eswatini and Lesotho : a systematic review of the characteristics, comprehensiveness, and quality of existing policies to improve community resilience to drought hazards

The southern African kingdoms of Eswatini and Lesotho experience recurrent drought-induced disasters. Policies have been enacted, but no attempt has been made to synthesise the effects on disaster resilience. This review analyses the characteristics, quality, and comprehensiveness of drought-resilience policies in Eswatini and Lesotho. We have systematically reviewed public policies that shape responses to disaster resilience published between 1 January 1980 and 30 June 2019. A combination of keywords was used to search electronic bibliographic databases, multidisciplinary databases, key organisational websites, and the first 20 pages of Google for policies that addressed disaster and/or drought resilience. Identified documents were downloaded into an EndNote database and screened for eligibility using predetermined criteria. The logic of events framework was used for quality assessment, and a metaethnographic approach was applied for data synthesis. Three broad categories of characteristics, thematic outcomes and quality, and comprehensiveness of policy documents emerged and are presented. Policy responses contributing to disaster resilience were found in n = 32 out of 13,700 documents. Three (n = 3/32) policies were statutory, and the rest were nonstatutory. Eleven (n = 11/32) were assessed to be of high quality. Policy responses relating to drought resilience focused on reducing vulnerability to recurrent disasters; promoting drought and climate change adaptation; improving agriculture and food security; safeguarding cultural heritage; and preventing gender inequality and gender-based violence as well as improving disaster governance. However, the construct of drought resilience was not strongly articulated as a major policy goal across policy documents. There is an urgent need to promote better understanding of drought resilience in order to motivate policymakers to steer away from reactive interventions and position resilience as a major national policy goal in both countries to expedite inclusive growth and safeguard development gains and the health and wellbeing of the majority of their populations who are rural-based populations

Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries : a systematic review and meta-analyses

The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I 2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI-0.32% to-0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide

Trends and impact factors of mental health service utilization among resettled humanitarian migrants in Australia : findings from the BNLA cohort study

Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries

Interpreting ambiguous ‘trace’ results in Schistosoma mansoni CCA Tests: Estimating sensitivity and specificity of ambiguous results with no gold standard

Background The development of new diagnostics is an important tool in the fight against disease. Latent Class Analysis (LCA) is used to estimate the sensitivity and specificity of tests in the absence of a gold standard. The main field diagnostic for Schistosoma mansoni infection, Kato-Katz (KK), is not very sensitive at low infection intensities. A point-of-care circulating cathodic antigen (CCA) test has been shown to be more sensitive than KK. However, CCA can return an ambiguous ‘trace’ result between ‘positive’ and ‘negative’, and much debate has focused on interpretation of traces results. Methodology/Principle findings We show how LCA can be extended to include ambiguous trace results and analyse S. mansoni studies from both Côte d’Ivoire (CdI) and Uganda. We compare the diagnostic performance of KK and CCA and the observed results by each test to the estimated infection prevalence in the population. Prevalence by KK was higher in CdI (13.4%) than in Uganda (6.1%), but prevalence by CCA was similar between countries, both when trace was assumed to be negative (CCAtn: 11.7% in CdI and 9.7% in Uganda) and positive (CCAtp: 20.1% in CdI and 22.5% in Uganda). The estimated sensitivity of CCA was more consistent between countries than the estimated sensitivity of KK, and estimated infection prevalence did not significantly differ between CdI (20.5%) and Uganda (19.1%). The prevalence by CCA with trace as positive did not differ significantly from estimates of infection prevalence in either country, whereas both KK and CCA with trace as negative significantly underestimated infection prevalence in both countries. Conclusions Incorporation of ambiguous results into an LCA enables the effect of different treatment thresholds to be directly assessed and is applicable in many fields. Our results showed that CCA with trace as positive most accurately estimated infection prevalence

Unexplained chronic liver disease in Ethiopia: a cross-sectional study

BACKGROUND: Hepatitis B virus (HBV) infection is assumed to be the major cause of chronic liver disease (CLD) in sub-Saharan Africa. The contribution of other aetiological causes of CLD is less well documented and hence opportunities to modulate other potential risk factors are being lost. The aims of this study were to explore the aetiological spectrum of CLD in eastern Ethiopia and to identify plausible underlying risk factors for its development. METHODS: A cross-sectional study was undertaken between April 2015 and April 2016 in two public hospitals in Harar, eastern Ethiopia. The study population comprised of consenting adults with clinical and radiological evidence of chronic liver disease. The baseline evaluation included: (i) a semi-structured interview designed to obtain information about the ingestion of alcohol, herbal medicines and local recreational drugs such as khat (Catha edulis); (ii) clinical examination; (iii) extensive laboratory testing; and, (iv) abdominal ultrasonography. RESULTS: One-hundred-and-fifty patients with CLD (men 72.0%; median age 30 [interquartile range 25-40] years) were included. CLD was attributed to chronic HBV infection in 55 (36.7%) individuals; other aetiological agents were identified in a further 12 (8.0%). No aetiological factors were identified in the remaining 83 (55.3%) patients. The overall prevalence of daily khat use was 78.0%, while alcohol abuse, defined as > 20 g/day in women and > 30 g/day in men, was rare (2.0%). Histological features of toxic liver injury were observed in a subset of patients with unexplained liver injury who underwent liver biopsy. CONCLUSION: The aetiology of CLD in eastern Ethiopia is largely unexplained. The widespread use of khat in the region, together with histopathological findings indicating toxic liver injury, suggests an association which warrants further investigation