Welcoming vulnerable children who need help from today\u27s church

https://place.asburyseminary.edu/ecommonsatsdissertations/2520/thumbnail.jp

Prospective Study of Proportions and Causes of Cancellation of Surgical Operations at Jimma University Teaching Hospital, Ethiopia

Background: Cancellation of scheduled surgery is a major quality of health care problem affecting the individual patients, family and the actual health care organization. Objective: The aim of this study was to assess the incidence, causes and magnitude of cancellation of elective surgical operations and to find the appropriate solutions for better patient management and effective utilization of resources. Methods: A longitudinal study design was conducted at Jimma University Teaching Hospital from February 1, 2014 to June 30, 2014. All consecutive scheduled cases (n=1438) to undergo elective surgical procedures were included in the study. Result: A total of 1438 patients were scheduled for elective surgical operations. Of these, 331(23.0%) were cancelled. about 45.6 % male and 54.4 % female ware not operated on the intended day of schedule respectively. General surgery had the highest rate of cancellations 198(23%) followed by orthopedic surgery 78(20%). In appropriate scheduling and unavailability of sterile drapes and lab sheets were the main causes of cancelation. Conclusion and Recommendation: Inappropriate scheduling and unavailability of sterile clothes were the main causes of Cancellation of elective surgical operations in our hospital. Concerned bodies should bring a sustainable change and improvement to prevent unnecessary cancellations and enhance cost effectiveness through communications, careful planning and efficient utilization of the available hospital resources

Optimierung der Saatgutgesundheit im ökologischen Arznei- und Gewürzpflanzenanbau

In dem BÖL Vorhaben „Optimierung der Saatgutqualität im ökologischen Arznei- und Gewürzpflanzenanbau“ Projekt 03OE127/1 (Laufzeit: 01.04.2004 – 31.12.2006) wurden schwerpunktmäßig Versuche zur Saatgutbehandlung durchgeführt. Für die Modellkulturen Anis, Dill, Fenchel, Koriander und Kümmel aus der Familie der Umbelliferae wurden Kenngrößen zum Einsatz von Pflanzenstärkungsmitteln zur Saatgutbehandlung erarbeitet und verschiedene physikalische Behandlungsmaßnahmen geprüft. Im Ergebnis dreier Jahre konnte kein durchgehend positiver Einfluss eines Pflanzenstärkungsmittels auf die Keimfähigkeit und den Feldaufgang ermittelt werden. Die physikalischen Behandlungsmaßnahmen (Heißwasserbehandlung, Elektronenbehandlung) zeigten in einzelne Pathosystemen sehr gute Wirksamkeiten. Ein kritischer Punkt dieser Behandlungen ist allerdings das Risiko eines Keimfähigkeitsverlustes. Die Versuchsarbeiten verdeutlichten, dass die Parameter der physikalischen Saatgutbehandlungen sehr genau auf die jeweils einzelne Saatgutpartie abgestimmt werden muß, um neben hohen Wirkungsgraden die Keimfähigkeit zu erhalten. Die Vakuum-Sattdampfbehandlung wurde als neueres Verfahren im Modell geprüft und erbrachte an Petersiliensaatgut eine Reduktion von Alternaria radicina. Ein weiterer Teilbereich des Projektes beschäftigte sich mit dem Einfluss pflanzenbaulichen Maßnahmen auf die Saatgutqualität. Im Besonderen wurde durch eine Variation des Erntezeitpunktes bei einigen Arten eine erhöhte Keimfähigkeit sowie unterschiedliche Befallsgrade von samenbürtigen Pathogen ermittelt. Neben den umfangreichen Arbeiten zur Saatgutqualität wurden die Saatgutpillierung von Petersilie und Kümmel untersucht. Die Schwierigkeit des Vorhabens lag im fehlenden Grundlagenwissen zu vielen Wirt-Pathogenbeziehungen. Resultierend aus den Versuchsarbeiten können der Praxis umfangreiche Erfahrungen zur Saatgutbehandlung vorgestellt werden. Die Arbeiten verdeutlichten, dass dem Produktionsfaktor Saatgut mehr Aufmerksamkeit geschenkt werden sollte und vor dem Anbau wichtige Qualitätsparameter (Keimfähigkeit, Befall mit samenbürtigen Pathogenen) beim Saatguthandel erfragt werden sollte

Leitfaden Saatgutgesundheit im Ökologischen Landbau - Gemüsekulturen

Im "Leitfaden Saatgutgesundheit im Ökologischen Landbau – Gemüsekulturen" werden ausgewählte saatgutbürtige Krankheiten von ackerbaulichen Kulturen samt vorbeugenden und direkten Regulierungsmöglichkeiten vorgestellt

Exploratory analysis of time from HIV diagnosis to ART start, factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia

Background: the HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors.Methods: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression.Results: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality.Conclusion and recommendation: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.Key words: HIV, HIV testing, enrollment, eligibility, antiretroviral therapy, mortality, Ethiopia

Return of chloroquine-sensitive Plasmodium falciparum parasites and emergence of chloroquine-resistant Plasmodium vivax in Ethiopia

BACKGROUND: Increased resistance by Plasmodium falciparum parasites led to the withdrawal of the antimalarial drugs chloroquine and sulphadoxine-pyrimethamine in Ethiopia. Since 2004 artemether-lumefantrine has served to treat uncomplicated P. falciparum malaria. However, increasing reports on delayed parasite clearance to artemisinin opens up a new challenge in anti-malarial therapy. With the complete withdrawal of CQ for the treatment of Plasmodium falciparum malaria, this study assessed the evolution of CQ resistance by investigating the prevalence of mutant alleles in the pfmdr1 and pfcrt genes in P. falciparum and pvmdr1 gene in Plasmodium vivax in Southern and Eastern Ethiopia. METHODS: Of the 1,416 febrile patients attending primary health facilities in Southern Ethiopia, 329 febrile patients positive for P. falciparum or P. vivax were recruited. Similarly of the 1,304 febrile patients from Eastern Ethiopia, 81 febrile patients positive for P. falciparum or P. vivax were included in the study. Of the 410 finger prick blood samples collected from malaria patients, we used direct sequencing to investigate the prevalence of mutations in pfcrt and pfmdr1. This included determining the gene copy number in pfmdr1 in 195 P. falciparum clinical isolates, and mutations in the pvmdr1 locus in 215 P. vivax clinical isolates. RESULTS: The pfcrt K76 CQ-sensitive allele was observed in 84.1% of the investigated P.falciparum clinical isolates. The pfcrt double mutations (K76T and C72S) were observed less than 3%. The pfcrt SVMNT haplotype was also found to be present in clinical isolates from Ethiopia. The pfcrt CVMNK-sensitive haplotypes were frequently observed (95.9%). The pfmdr1 mutation N86Y was observed only in 14.9% compared to 85.1% of the clinical isolates that carried sensitive alleles. Also, the sensitive pfmdr1 Y184 allele was more common, in 94.9% of clinical isolates. None of the investigated P. falciparum clinical isolates carried S1034C, N1042D and D1246Y pfmdr1 polymorphisms. All investigated P. falciparum clinical isolates from Southern and Eastern Ethiopia carried only a single copy of the mutant pfmdr1 gene. CONCLUSION: The study reports for the first time the return of chloroquine sensitive P. falciparum in Ethiopia. These findings support the rationale for the use of CQ-based combination drugs as a possible future alternative

Magnitude of Antiretroviral Drug toxicity in adult HIV patients in Ethiopia: A cohort study at seven teaching hospitals

Background: The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia.Methods: This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity.Result: ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems – the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity.Conclusion: ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available.Key words: HIV, ART, adverse drug reaction, incidence rate, ACM, Ethiopi

Factors associated with mortality of TB/HIV co-infected patients in Ethiopia

Background: Despite the large number of TB patients on ART in Ethiopia, their mortality remains high. This study reports the effect of TB on HIV related mortality and determinants of TB/HIV co-infection related mortality.Methods: A longitudinal study design was employed as part of the Advanced Clinical Monitoring of ART (ACM) in Ethiopia. All patients started on ART at or after January 1, 2005 were included. Survival analysis was done to compare survival patterns of HIV patients with TB against HIV patients without TB. In addition, determinants of survival among TB/HIV co-infected patients were analyzed. Adjusted effects of the different factors on time to death were generated using Cox-proportional hazards regression.Results: A total of 3,889 patients were enrolled in the ACM study, of which 355 TB cases were identified, making the crude prevalence 9% (95% CI 8.3 – 10.2). Overall, incidence of TB was 2.2 (95% CI 1.9-2.4) per 100 person-years. TB was highest in the first 2 months and declined with time on ART to reach 1 per 100 person years after 24 months on ART. TB was significantly associated with mortality among HIV patients on HAART (AHR 2.0, 95% CI 1.47-2.75). Male gender was associated with mortality among TB/HIV co-infected patients.Conclusion: Tuberculosis plays a key role in HIV associated mortality. Targeted interventions which can keep patients free of TB in the early stages of their treatment are required to reduce TB related mortality.Key Words: Tuberculosis, Antiretroviral therapy, Mortalit

Predictors of survival among adult Ethiopian patients in the national ART program at Seven University Teaching Hospitals: A prospective cohort study

Background: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients,  started in the national ART program from January 2009 to July 2013.Methods: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 - July 2013. Kaplan-Meier and Cox  regression analyses were used to estimate survival and determine risk factors for death.Results: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/μl (interquartile range (IQR) 78-205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7-5.7) at base line. One hundred and one deaths were recorded during  follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4-6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037).Conclusion: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.Key Words: Ethiopia, HIV clinical cohort, Antiretroviral therapy, Surviva

Invasive Water Hyacinth Challenges, Opportunities, Mitigation, and Policy Implications: The Case of the Nile Basin

Many lakes and rivers all over the globe are experiencing environmental, human health, and socio-economic development issues due to the spread of invasive water hyacinth (WH) weed. WH is regarded as one of the world’s most destructive weeds and is nearly impossible to control and eliminate due to its rapid expansion and ability to double its coverage area in 13 days or fewer. However, most people in developing countries appear to be hoping for a miraculous cure; there are none and never will be. In this regard, this chapter aims to give an insight to raise awareness, research its biology and challenges, management options, and potential prospects on integrated control-valorization and its policy implications. WH biomass has demonstrated potential as a biorefinery feedstock for bioenergy and biofertilizer production, heavy metal phytoremediation, handicraft and furniture making, animal feed, and other applications. As a result, large-scale integrated control and valorization is an economically viable strategy for preventing further infestation through incentivizing WH control: providing a sustainable environment, increasing energy mix, increasing fertilizer mix, increasing food security, reducing GHG emissions, boosting socio-economic development, and creating new green jobs for local and riparian communities. Therefore, it is a leap forward in addressing global sustainable development goals (SDGs) through the water-energy-food-ecosystem (WEFE) nexus