A 3- Year Review of Patients with Chronic Empyema Treated Surgically at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Background: Empyema thoracic is one of the main causes of morbidity and mortality in developing countries. This study was aimed at determining the causes, clinical presentation, outcomes of surgical intervention and variables associated with adverse outcomes in patients with chronic empyema treated surgically. Methods: This was a cross sectional hospital based longitudinal case series analysis done at Tikur Anbessa Specialized referral hospital, Addis Ababa, Ethiopia. All patients admitted and operated for chronic Empyema over a period of three year. (April 01, 2011 - March 30, 2014) were studied. Results: A total of 62 patients were operated for empyema thoracis. The Male to female ratio was 5.9:1 and mean age at presentation was 29.96+/-10.6 years. Patients presented after an average of 8.02 +/- 4.37 months from the onset of symptoms (range from 1-16 months). Shortness of breath 43(69.4%), cough 43(69.4%), chest pain 47(75.8%), fever 30(48.4%), weight loss 21(33.9%) poor appetite 9(14.5%) and haemoptysis 1(1.6%) were the leading causes of symptoms on admission. Thirty seven (59.7%) patients were previously treated for tuberculosis, 11 (17.7%) had pneumonia and 53(85.5%) of them gave history of trauma. The right {32(51.6%)} and left pleural space, {29(46.8%)} were affected with similar incidence. Only one patient was admitted with bilateral empyema. In the majority of patients, 46(74.2%), open thoracotomy with abscess drainage and decortications were done. In addition to this, either lobectomy or pnemonectomy was done for 4 (6.5%) and 7 (11.3%) patients respectively. Three patients were treated by rib resection and open drainage. The average post-operative hospital stay was 12 days (range 3 - 63days). Major complications encounter were lung laceration 15(24.2%), BPF 8(12.9), recurrent empyema 10(16.1%), and persistent air space 14(22.6%). Two (3.2%) patients died in their hospital stay. During follow up visits, 52(83.9%) patients had shown significant subjective improvement of symptoms. Conclusion: In general, our experience on the outcome of open thoracotomy and decortication done for chronic empyema was excellent with low mortality and very good Functional results as majority of patients either returned to normal activities or showed significant improvement of symptoms.Key words: Chronic Empyema, Decortication, Bronchopleural fistul

Trauma in Ethiopia Revisited: A systematic Review

Background: This is a systematic review on trauma/injury incidents which has tried to examine the variety of socio-demographic, vehicular,  environmental, and behavioral factors that are associated with injury and its outcome across different settings.Data Sources: Electronic searches for trauma/injuries from peer-reviewed literature and websites from 1960 to August 2013.Study Selection: 36 studies met the study inclusion criteria.Data Extraction: A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables.Results: A higher proportion of injury was found in economically active age groups of 15-59 years (Range 56.4 %–80%) across all studies. Similarly majority of the articles reported a higher proportion (Mostly 2/3rd) of injuries among male than female patients (range 53.9 %-91.2 %). Eventhough in all studies injuries were a concern for every population, some studies [12, 13, 15, and, 29] showed a higher incidence among farmers, students and house wife that other occupation. Unintentional injuries were the primary cause for the majority of injury-related reports made withthe weighted pool average percentage of 60.7% (range from 44.6 %11 to 98%20). MVIs were the leading cause of injury among lists of unintentional injuries followed by Falls (16%) machine/tools injury (5.9%), burn (5.3%), poisoning (1.0%) and Animal bite (1.3%). Trauma from interpersonalviolence (Homicide) is the leading causes of intentional injury (24.4%) reported followed by disproportionately low incidence of Fire arm(5%) and Self-harm injuries( 2.1%). Nine of the 36 articles reported percentage distribution of Mortality by Mechanism of injury and the rates of deathfrom MVIs and homicide are generally higher with an average weighted pool percentage of 37.5% and 24.1% respectively.Conclusion: The review showed injury as a significant cause of morbidity and mortality in Ethiopia. Based on the available data, possible strategies relating to trauma prevention are discussed. Because of the uncertainties about the quality and the absence of some data in certain region of Ethiopia, we recommend a need to more accurately define this burden at a national scale.Key words: Trauma, Injury, Accident, Ethiopi

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

Opportunities and Challenges of Harnessing Biomass Wastes for Decentralized Heat and Energy Generation and Climate Mitigation via Fluidized-bed Gasification Pathway

Biomass wastes offer immense potential as a renewable energy source, holding the promise to replace fossil fuels for heat and energy generation, in particular for decentralized power production. Furthermore, the utilization of biomass promotes circular economy by enabling the conversion of local resources into useful products and energy. However, the conversion of biomass into end-use products and heat/energy is a complex process with multiple pathways, such as fluidized bed gasification, a well-established and efficient method for converting coal and biomass into heat. Despite its merits, this process is currently limited to industrial applications and encounters certain limitations and obstacles. Notably, the low energy density of biomass wastes and downstream pipe contamination from tar and polycyclic aromatic hydrocarbon (PAH) growth poses significant technological challenges. Nonetheless, a roadmap has been developed to guide the widespread adoption of fluidized bed gasification of biomass for decentralized power generation and climate mitigation. This book chapter delves into the opportunities and challenges of fluidized bed gasification as a viable option for decentralized power generation and climate mitigation through biomass waste conversion. The significance of well-crafted policies supporting renewable energy sources and optimizing fluidized bed gasifiers to achieve desirable end products are also emphasized

Predictors of unintended pregnancy in Kersa, Eastern Ethiopia, 2010

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, little is known about pregnancy among rural women. Proper maternal health care depends on clear understanding of the reproductive health situation. The objective of this study was to identify predictors of unintended pregnancy in rural eastern Ethiopia.</p> <p>Methodology</p> <p>This study was part of pregnancy surveillance at Kersa Demographic Surveillance and Health Research Center, East Ethiopia. Pregnant women were assessed whether their current pregnancy was intended or not. Data were collected by lay interviewers using uniform questionnaire. Odds Ratio, with 95% confidence interval using multiple and multinomial logistic regression were calculated to detect level of significance.</p> <p>Results</p> <p>Unintended pregnancy was reported by 27.9% (578/2072) of the study subjects. Out of which, 440 were mistimed and 138 were not wanted. Unintended pregnancy was associated with family wealth status (OR 1.47; 95% CI 1.14, 1.90), high parity (7 +) (OR 5.18; 95% CI 3.31, 8.12), and a longer estimated time to walk to the nearest health care facility (OR 2.24; 95% CI: 1.49, 3.39).</p> <p>In the multinomial regression, women from poor family reported that their pregnancy was mistimed (OR 1.69; 95% CI 1.27, 2.25). The longer estimated time (80 + minutes) to walk to the nearest health care facility influenced the occurrence of mistimed pregnancy (OR 2.58; 95% CI: 1.65, 4.02). High parity (7+) showed a strong association to mistimed and unwanted pregnancies (OR 3.11; 95% CI 1.87, 5.12) and (OR 14.34; 95% CI 5.72, 35.98), respectively.</p> <p>Conclusions</p> <p>The economy of the family, parity, and walking distance to the nearest health care institution are strong predictors of unintended pregnancy. In order to reduce the high rate of unintended pregnancy Efforts to reach rural women with family planning services should be strengthened.</p

Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh

© 2018 The Author(s). Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia.</p> <p>Methods</p> <p>In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.</p> <p>Results</p> <p>After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).</p> <p>Conclusion</p> <p>The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.</p

Genotype characterization of Epstein–Barr virus among adults living with human immunodeficiency virus in Ethiopia

BackgroundEpstein–Barr virus (EBV) is a human lymphotropic herpesvirus with a causative agent in cancer. There are two genotypes of EBV (EBV genotype 1 and EBV genotype 2) that have been shown to infect humans. This study aimed to characterize the EBV genotype among people with human immunodeficiency virus (PWH) and HIV-negative individuals in Ethiopia.MethodsDNA was extracted from peripheral blood mononuclear cells (PBMCs). Conventional polymerase chain reaction (cPCR) targeting EBNA3C genes was performed for genotyping. A quantitative real-time PCR (q-PCR) assay for EBV DNA (EBNA1 ORF) detection and viral load quantification was performed. Statistical significance was determined at a value of p &lt; 0.05.ResultIn this study, 155 EBV-seropositive individuals were enrolled, including 128 PWH and 27 HIV-negative individuals. Among PWH, EBV genotype 1 was the most prevalent (105/128, 82.0%) genotype, followed by EBV genotype 2 (17/128, 13.3%), and mixed infection (6/128, 4.7%). In PWH, the median log10 of EBV viral load was 4.23 copies/ml [interquartile range (IQR): 3.76–4.46], whereas it was 3.84 copies/ml (IQR: 3.74–4.02) in the HIV-negative group. The EBV viral load in PWH was significantly higher than that in HIV-negative individuals (value of p = 0.004). In PWH, the median log10 of EBV viral load was 4.25 copies/ml (IQR: 3.83–4.47) in EBV genotype 1 and higher than EBV genotype 2 and mixed infection (p = 0.032).ConclusionIn Ethiopia, EBV genotype 1 was found to be the most predominant genotype, followed by EBV genotype 2. Understanding the genotype characterization of EBV in PWH is essential for developing new and innovative strategies for preventing and treating EBV-related complications in this population