Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study

<p>Abstract</p> <p>Background</p> <p>The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend.</p> <p>Objectives</p> <p>The overall aim of this study was to analyze trends of and develop model for prediction of Health and Health related indicators. More specifically, it described the trends of Health and Health related indicators, identified determinants of mortality and morbidity indicators and developed model for predicting future values of MDG indicators.</p> <p>Methods</p> <p>This study was conducted on Health and Health related indicators of Ethiopia from the year 1987 E.C to 2000 E.C. Key indicators of Mortality and Morbidity, Health service coverage, Health systems resources, Demographic and socio-economic, and Risk factor indicators were extracted and analyzed. The trends in these indicators were established using trend analysis techniques. The determinants of the established trends were identified using ARIMA models in STATA. The trend-line equations were then used to predict future values of the indicators.</p> <p>Results</p> <p>Among the mortality indicators considered in this study, it was only Maternal Mortality Ratio that showed statistically significant decrement within the study period. The trends of Total Fertility Rate, physician per 100,000 population, skilled birth attendance and postnatal care coverage were found to have significant association with Maternal Mortality Ratio trend. There was a reversal of malaria parasite prevalence in 1999 E.C from <it>Plasmodium Falciparum </it>to <it>Plasmodium Vivax</it>. Based on the prediction from the current trend, the Millennium Development Goal target for under-five mortality rate and proportion of people having access to basic sanitation can be achieved.</p> <p>Conclusion</p> <p>The current trend indicates the need to accelerate the progress of the indicators to achieve MDGs at or before 2015, particularly for Maternal Health and access to safe water supply.</p

Rangeland condition and feed resources in Metema district, North Gondar Zone, Amhara Region, Ethiopia

The study was conducted in 2006/07 in Metema district, North Gondar Zone of Amhara region, Ethiopia, with the objectives to characterize the existing rangeland and to determine the feed resources utilization practices, to assess the natural grazing land condition based on herbaceous, woody and soil condition and to evaluate the chemical composition of major livestock feed resources of the area. A single-visit formal survey, group discussions and visual observations are used to collect the primary information and secondary sources are also used in livestock feed resources assessment of the district. A total of 140 respondents from 7 kebeles were selected for interviewing by stratified random sampling techniques. To assess the range conditions, the samples were collected by classifying the district into cotton–livestock and sesame–livestock farming systems. Within a farming system, grazing lands were further stratified into three sampling areas: communal, road side and enclosure grazing areas. In each of the range sites a sampling block of 4 km × 1 km was demarcated and this was further stratified into four sampling plots of equal size. In each of the plot, a belt transects of 50 m × 4 m was laid out randomly. Then, the parameter used for (herbaceous, soil and woody) grass species composition, basal cover, litter cover, soil erosion, soil compaction, seedling count, age distribution and woody density enumeration, canopy cover and hedging were determined. For the height classes 1–3 m, >3–4.5 m and >4.5 m was used. Feed samples were stratified by season and types and subjected to chemical analysis for determination of DM, ash, CP, ADF, ADL and IVDMD. About 83% of the inhabitants in the district practice mixed crop–livestock farming system. The mean family size is 5.31 ± 0.20 persons per household, while the average land holding is 6.78 ± 1.33 ha/household. The mean livestock holding per household is 12.52 ± 6.23 TLU, and is composed of cattle, goats, sheep, donkeys and camels. Natural pasture (55.7%), crop residues (20.7%), stubble (14.3%) and hay (9.3%) are the major feed resources for dry season whereas in the wet season only natural pasture serves as feed resource. The total estimated DM yield of grazing land and stubble is 780,750 and 51,954 t DM per annum, respectively. The total estimated available feed supply is 833,531.2 t DM per annum. Of the identified 33 herbaceous species, 14 and 19 are different grasses and non-grass species. From the non-grass species 6 legumes and 13 sedges and other species are recorded. Of the grasses, 23.07%, 38.46% and 30.77% are highly desirable, desirable and less desirable, respectively. Of the identified 20 woody species, 15%, 35%, and 50% are highly desirable, desirable and less desirable, respectively. The largest proportion of woody vegetation is contributed by different species of acacia (20%)and commbretum (10%). Trees and shrubs grouped within the height class of >1–3 m constituted 41.2% in communal grazing areas, 38.5% in road side grazing and 33.3% in enclosures. Range condition assessment factors such as basal cover, litter cover, grass species composition, woody vegetation density, canopy cover, hedging effect, age distribution and total condition score are significant (P<0.05) in communal grazing areas of the sesame–livestock than in the cotton–livestock farming system. The communal grazing areas have significantly (P< 0.05) higher values of grass species composition, basal cover, litter cover, age distribution, and woody species density score, than the road side grazing areas and lower (P<0.05) than the enclosure grazing areas. The dry matter biomass of grass, highly desirable, desirable species of grasses and legumes and others obtained in the same farming system were significantly (P<0.05) higher than the road side grazing types and lower (P<0.05) in total grass biomass, highly desirable grass, and total biomass than enclosure areas. The total dry matter biomass, dry matter biomass of grass and highly desirable grasses, and legumes are significantly (P<0.05) higher in the enclosure followed by communal grazing and the road side grazing areas. In general, there is low feed resources conservation and utilization and very poor traditional grazing land management system in Metema. The abundant feed resources in the wet season are wasted. In the dry season, grasses are turned to ash by wild and man-made fire in the process of forest honey harvesting and crop land cleaning. As a result, the livestock populations seriously suffer from the critical feed shortage during the long dry season.The rangeland, species composition and biomass production are also affected by human, livestock and natural factors (biotic and abiotic factors). The human population of the district has increased due to settlement programs, investment induced settlers, expanding crop cultivation and have increased the pressure on the rangelands and natural grazing areas. Bush encroachment and overgrazing are also serious problems. Shifting cultivation practice is also contributing to the increased bush encroachment. The seasonal movement and transhumant livestock production by highlanders in adjacent districts also increases the grazing intensity. Absence of adequate baseline information about the rangeland resources, unsynchronized seasonal availability of feed resources and cropland encroachment to the rangeland are some of the main constraints of the district, and studies on rangeland management systems and improved livestock production should be initiated

Comparative study on the level of bacteriological contamination of automatic teller machines, public toilets and public transport commercial motorcycle crash helmets in Kigali City, Rwanda

Background: The environments can be contaminated by infectious agents that constitute a major health hazards as sources of community and hospital-acquired infections due to various activities.Objective: A comparative study on the level of bacteriological  contamination of automatic teller machines (ATMs), public toilets and commercial motorcycle crash helmets were conducted in Kigali city during the period of January to March, 2013.Design: Samples were collected from selected ATMs, public toilets and commercial motorcycle crash helmets surfaces. Micro-organisms identified from these samples were associated to infecting organisms recovered from unwashed hands surfaces and recorded results in the nearby hospital.Setting: Samples from each device and subject were transported to the laboratory where they were analysed for the presence of coliforms and other airborne, human skin and intestinal disease causing microorganisms. Microbiological methods including spread plate techniques and some  biochemical tests were used to partially identify the microorganisms.Subjects: Subjects involved in this study were consented students from University  of Rwanda and Kigali motorcyclists for collections of samples from hands and crash helmets respectively.Results: The following pathogenic bacteria have been found on the devices, Staphylococcus aureus, Staphylococcus epidermis, Streptococcus species, Escherichia coli, Salmonella, Klebsiella, Enterobacter aerogenes, Pseudomonas. The commercial motorcycle crash helmets had the highest level of bacteriological contamination compared to ATMs and public toilets. There was no growth observed on samples collected after treatment from ATMs, public toilets, and commercial motorcycle crash helmets. Attempt to correlate this finding with infecting organisms recovered from unwashed hands surfaces and recorded results in the nearby hospital show that thepresences of some of these infectious pathogens. Conclusion: This study has revealed the ability of these public devices to serve as vehicle of transmission of microorganisms with serious health implications. To improve and ensure the safety of these public devices the use of disinfectants is of high importance on reducing bacteriological load on those public devices. Proper cleaning regimen to sanitise these facilities regularly and public education on their hygienic usage are recommended to reduce the associated risks

Has oral fluid the potential to replace serum for the evaluation of population immunity levels? A study of measles, rubella and hepatitis B in rural Ethiopia.

OBJECTIVE: To assess the suitability of using oral-fluid samples for determining the prevalence of immunity to vaccine-preventable infections. METHODS: Paired blood and oral-fluid samples were obtained from 853 individuals of all ages from a rural Ethiopian community. Oral fluid around the gums was screened for measles- and rubella-specific antibodies using enhanced IgG antibody capture (GAC) enzyme-linked immunosorbent assays (ELISAs), and for anti-HBc antibodies using a prototype GACELISA. IgG antibodies in serum to measles, rubella and HBc were determined using commercial ELISAs. FINDINGS: Relative to serum, oral fluid assay sensitivity and specificity were as follows: 98% and 87% for measles, 79% and 90% for rubella, and 43% and 87% for anti-HBc. These assay characteristics yielded population prevalence estimates from oral fluid with a precision equal to that of serum for measles (all ages) and rubella (ages < 20 years). CONCLUSION: Our results suggest that oral fluid could have the potential to replace serum in IgG antibody prevalence surveys. Further progress requires assessment of variation in assay performance between populations as well as the availability of standardized, easy to use assays

Assessment of measles immunity among infants in Maputo City, Mozambique

<p>Abstract</p> <p>Background</p> <p>The optimum age for measles vaccination varies from country to country and thus a standardized vaccination schedule is controversial. While the increase in measles vaccination coverage has produced significant changes in the epidemiology of infection, vaccination schedules have not been adjusted. Instead, measures to cut wild-type virus transmission through mass vaccination campaigns have been instituted. This study estimates the presence of measles antibodies among six- and nine-month-old children and assesses the current vaccination seroconversion by using a non invasive method in Maputo City, Mozambique.</p> <p>Methods</p> <p>Six- and nine-month old children and their mothers were screened in a cross-sectional study for measles-specific antibodies in oral fluid. All vaccinated children were invited for a follow-up visit 15 days after immunization to assess seroconversion. </p> <p>Results</p> <p>82.4% of the children lost maternal antibodies by six months. Most children were antibody-positive post-vaccination at nine months, although 30.5 % of nine month old children had antibodies in oral fluid before vaccination. We suggest that these pre-vaccination antibodies are due to contact with wild-type of measles virus. The observed seroconversion rate after vaccination was 84.2%. </p> <p>Conclusion</p> <p>These data indicate a need to re-evaluate the effectiveness of the measles immunization policy in the current epidemiological scenario.</p

Assessment of routine surveillance data as a tool to investigate measles outbreaks in Mozambique

BACKGROUND: Measles remains a major public health problem in Mozambique despite significant efforts to control the disease. Currently, health authorities base their outbreak control on data from the routine surveillance system while vaccine coverage and efficacy are calculated based on mathematical projections of the target population. The aim of this work was to assess the quality of the measles reporting system during two outbreaks that occurred in Maputo City (1998) and in Manica Province (2002). METHODS: Retrospectively, we collected data from the routine surveillance system, i.e. register books at health facilities and weekly provincial and national epidemiological reports. To test whether the provinces registered an outbreak, the distribution of measles cases was compared to an endemic level established based on cases reported in previous years. RESULTS: There was a significant under-notification of measles cases from the health facilities to the province and national level. Register books, the primary sources of information for the measles surveillance system, were found to be incomplete for two main variables: "age" and "vaccination status". CONCLUSION: The Mozambican surveillance system is based on poor quality records, receives the notification of only a fraction of the total number of measles in the country and may result in failures do detect epidemics. The measles reporting system does not provide the data needed by Expanded Program on Immunisation managers to make evidence-based decisions, nor does it allow in-depth analysis to monitor measles epidemiology in the country. The progress of Mozambique to the next stage of measles elimination will require an improvement of the routine surveillance system and a stronger Health Information System

In vivo efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in Central Ethiopia

<p>Abstract</p> <p>Background</p> <p><it>In vivo </it>efficacy assessments of the first-line treatments for <it>Plasmodium falciparum </it>malaria are essential for ensuring effective case management. In Ethiopia, artemether-lumefantrine (AL) has been the first-line treatment for uncomplicated <it>P. falciparum </it>malaria since 2004.</p> <p>Methods</p> <p>Between October and November 2009, we conducted a 42-day, single arm, open label study of AL for <it>P. falciparum </it>in individuals >6 months of age at two sites in Oromia State, Ethiopia. Eligible patients who had documented <it>P. falciparum </it>mono-infection were enrolled and followed according to the standard 2009 World Health Organization <it>in vivo </it>drug efficacy monitoring protocol. The primary and secondary endpoints were PCR uncorrected and corrected cure rates, as measured by adequate clinical and parasitological response on days 28 and 42, respectively.</p> <p>Results</p> <p>Of 4426 patients tested, 120 with confirmed falciparum malaria were enrolled and treated with AL. Follow-up was completed for 112 patients at day 28 and 104 patients at day 42. There was one late parasitological failure, which was classified as undetermined after genotyping. Uncorrected cure rates at both day 28 and 42 for the per protocol analysis were 99.1% (95% CI 95.1-100.0); corrected cure rates at both day 28 and 42 were 100.0%. Uncorrected cure rates at day 28 and 42 for the intention to treat analysis were 93.3% (95% CI 87.2-97.1) and 86.6% (95% CI 79.1-92.1), respectively, while the corrected cure rates at day 28 and 42 were 94.1% (95% CI 88.2-97.6) and 87.3% (95% CI 79.9-92.7), respectively. Using survival analysis, the unadjusted cure rate was 99.1% and 100.0% adjusted by genotyping for day 28 and 42, respectively. Eight <it>P. falciparum </it>patients (6.7%) presented with <it>Plasmodium vivax </it>infection during follow-up and were excluded from the per protocol analysis. Only one patient had persistent parasitaemia at day 3. No serious adverse events were reported, with cough and nausea/vomiting being the most common adverse events.</p> <p>Conclusions</p> <p>AL remains a highly effective and well-tolerated treatment for uncomplicated falciparum malaria in the study setting after several years of universal access to AL. A high rate of parasitaemia with <it>P. vivax </it>possibly from relapse or new infection was observed.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01052584">NCT01052584</a></p

A review of data needed to parameterize a dynamic model of measles in developing countries

<p>Abstract</p> <p>Background</p> <p>Dynamic models of infection transmission can project future disease burden within a population. Few dynamic measles models have been developed for low-income countries, where measles disease burden is highest. Our objective was to review the literature on measles epidemiology in low-income countries, with a particular focus on data that are needed to parameterize dynamic models.</p> <p>Methods</p> <p>We included age-stratified case reporting and seroprevalence studies with fair to good sample sizes for mostly urban African and Indian populations. We emphasized studies conducted before widespread immunization. We summarized age-stratified attack rates and seroprevalence profiles across these populations. Using the study data, we fitted a "representative" seroprevalence profile for African and Indian settings. We also used a catalytic model to estimate the age-dependent force of infection for individual African and Indian studies where seroprevalence was surveyed. We used these data to quantify the effects of population density on the basic reproductive number <it>R</it>₀.</p> <p>Results</p> <p>The peak attack rate usually occurred at age 1 year in Africa, and 1 to 2 years in India, which is earlier than in developed countries before mass vaccination. Approximately 60% of children were seropositive for measles antibody by age 2 in Africa and India, according to the representative seroprevalence profiles. A statistically significant decline in the force of infection with age was found in 4 of 6 Indian seroprevalence studies, but not in 2 African studies. This implies that the classic threshold result describing the critical proportion immune (<it>p</it>_c) required to eradicate an infectious disease, <it>p</it>_c= 1-1/<it>R</it>₀, may overestimate the required proportion immune to eradicate measles in some developing country populations. A possible, though not statistically significant, positive relation between population density and <it>R</it>₀for various Indian and African populations was also found. These populations also showed a similar pattern of waning of maternal antibodies. Attack rates in rural Indian populations show little dependence on vaccine coverage or population density compared to urban Indian populations. Estimated <it>R</it>₀values varied widely across populations which has further implications for measles elimination.</p> <p>Conclusions</p> <p>It is possible to develop a broadly informative dynamic model of measles transmission in low-income country settings based on existing literature, though it may be difficult to develop a model that is closely tailored to any given country. Greater efforts to collect data specific to low-income countries would aid in control efforts by allowing highly population-specific models to be developed.</p