Improving sensitivity of oral fluid testing in IgG prevalence studies: application of mixture models to a rubella antibody survey

A method for the analysis of age-stratified antibody prevalence surveys is applied to a previously reported survey of antibody to rubella virus using oral fluid samples in which the sensitivity of the assay used was shown to be compromised. The age-specific distribution of the quantitative results of antibody tests using oral fluids is modelled as a mixture of strong positive, weak positive and negative components. This yields maximum likelihood estimates of the prevalence at each age and demonstrates that, when used in conjunction with mixture modelling techniques, the results of antibody prevalence studies using oral fluids accurately reflect those obtained using sera

Sero-epidemiology of rubella in the urban population of Addis Ababa Ethiopia

We conducted a community-based cluster sample survey of rubella sero-epidemiology in Addis Ababa, Ethiopia in 1994. Among 4666 individuals for whom complete data were available, rubella antibody prevalence was 91% (95% confidence interval: 90, 92). On multivariable analysis, seroprevalence was lower among individuals who were resident in Addis Ababa for 1 year or less. Approx. 50% seroprevalence was attained by age 4 years, and the estimated average age at infection was 5·2 years. The highest age-specific force of infection was estimated to occur in 5- to 9-year-olds. The early age at infection corresponded with a low estimated incidence of congenital rubella syndrome (CRS) of 0·3 per 1000 live births, equivalent to nine cases of CRS in 1994. The predicted critical level of immunity for elimination of rubella via vaccination was 85–91%, requiring 89–96% coverage with a vaccine of 95% effectiveness. Unless very high coverage of rubella vaccine could be guaranteed, the introduction of childhood vaccination could increase the incidence of CRS in Addis Ababa

X-ray film reject rate analysis at eight selected government hospitals in Addis Ababa, Ethiopia, 2010

Background: Improper practices in radiography that lead to possible repeating of procedures predispose patients for additional cost, more waiting time, and excess dose of ionizing radiation, leading to various dose dependent and dose independent health problems including cancer. In the face of such problems and the scarcity of resources, improvingthe quality and efficiency of radiology services is imperative.Objective: The purpose of this research was to identify the main causes of film faults as well as the pattern and magnitude of film rejection.Methods: Using a prospective cross-sectional hospital based approach; eight public hospitals were selected in Addis Ababa through convenience sampling. Adult and pediatrics radiographs with film faults were reviewed using a standardized checklist of common causes of reject. The collected data were then entered into a database for analysis using descriptive statistics.Results: Reject rate was calculated in eight governmental hospitals across all plain film examinations. The overall reject rate was 374 (3.1 %) in 12,165 x-ray exposures. Total reject rate by hospital showed 10.5% for Zewditu and 1.53% and 1.87% for Tikur Anbessa Specialized Hospital (TASH) and the Police Hospital, respectively.Conclusions: Rejected films were found to have been caused by numerous factors including poor technical judgment, patient motion, and poor supervision of staff. Hence, strategies need to be developed within medical imaging departments to improve the situation.[Ethiop. J. Health Dev. 2012;26(1):54-59

RESULTS OF A FARM AND MARKET SURVEY FOR HMONG SPECIALTY CROP FARMERS IN THE MINNEAPOLIS, ST. PAUL METRO AREA

This report is part of a larger project, "Risk Management Education and Farm Management Development Program for Hmong Specialty Crop Farmers in the Minneapolis, St. Paul Metro Area," funded by the Risk Management Agency, U.S. Department of Agriculture. The project was designed to assist Hmong farmers in the Twin Cities area in improving their production and management practices so they are able to increase their economic viability and reduce their exposure to risk. As part of the overall project, 62 Hmong farmers and 69 customers at farmers markets were surveyed to determine the local specialty crop production and market conditions. The findings of these 2 surveys are contained in the report. The median size of the 62 farms surveyed farms was 3 acres. Forty-two percent of those farmers responding reported total farm product sales between $3,000 and$8,999. Few farmers indicated they were familiar with crop insurance programs. Sixty-eight percent of the 19 farmers responding (or 21% of the 62 surveyed) said they were familiar with multi-peril crop insurance (MPCI). Only 12% of the 50 farmers responding had bought crop insurance in 2002. The most frequently indicated needs for future education programs were production oriented: weed control, insect control, fertilization, and pesticide safety. All of the 69 customers surveyed regularly bought some kind of vegetables or herbs. Over half of the customers bought potatoes, snap beans, peppers, sweet corn, carrots, cucumbers, basil, and winter squash. Eighty-eight percent of customers indicated they typically spend between $10 and$29 on vegetables and herbs during each visit to a farmers' market.Crop Production/Industries,

Pastoralists do plan! Community-led land use planning in the pastoral areas of Ethiopia

This paper consolidates a set of case studies which document how pastoralists plan land and resource use in pastoral and agro-pastoral areas of Ethiopia. These case studies are drawn from the regional states of Afar, Somali, Southern Nations, Nationalities, and Peoples (SNNP), Oromia, and Gambella. They describe not only why, how, and when pastoralists plan, but also the management and governance structures that control planning processes and the later implementation of the plans. By doing this, the paper provides guidance on how best such planning processes can be supported, and how they can be integrated with and/or built on by other planning processes such as those led by government

Mapping the vegetation of the Lake Tana basin, Ethiopia, using Google Earth images

The basin of Lake Tana is one of the most important watersheds in the Nile Basin. It is of great significance to the economy and politics of Ethiopia. In the past, the natural vegetation of the Lake Tana basin was heavily damaged to facilitate the continued expansion of cropland. Vegetation must be conserved and restored to protect the natural environment and maintain the biodiversity of the Lake Tana basin. In this research, we mapped the vegetation of the Lake Tana basin through visual interpretation using high-spatial-resolution images provided by Google Earth and field survey data to provide detailed information of the actual vegetation state for planning conservation and restoration. A total of 33&thinsp;171 polygons were generated to represent the vegetation patches of the Lake Tana basin on the map, and the validation using surveyed vegetation plots indicated that 90&thinsp;% of the patches were correctly identified. The DOI of the dataset used for map production is https://doi.org/10.4121/uuid:48d45053-36f6-411b-96b1-7ae0e22d56d0. We expect that this vegetation map could benefit vegetation conservation and restoration in the Lake Tana basin.</p

A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa

Background Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed. Methods A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis. Results Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA. Conclusions For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care

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

Malaria in Africa: Vector Species' Niche Models and Relative Risk Maps

A central theoretical goal of epidemiology is the construction of spatial models of disease prevalence and risk, including maps for the potential spread of infectious disease. We provide three continent-wide maps representing the relative risk of malaria in Africa based on ecological niche models of vector species and risk analysis at a spatial resolution of 1 arc-minute (9 185 275 cells of approximately 4 sq km). Using a maximum entropy method we construct niche models for 10 malaria vector species based on species occurrence records since 1980, 19 climatic variables, altitude, and land cover data (in 14 classes). For seven vectors (Anopheles coustani, A. funestus, A. melas, A. merus, A. moucheti, A. nili, and A. paludis) these are the first published niche models. We predict that Central Africa has poor habitat for both A. arabiensis and A. gambiae, and that A. quadriannulatus and A. arabiensis have restricted habitats in Southern Africa as claimed by field experts in criticism of previous models. The results of the niche models are incorporated into three relative risk models which assume different ecological interactions between vector species. The “additive” model assumes no interaction; the “minimax” model assumes maximum relative risk due to any vector in a cell; and the “competitive exclusion” model assumes the relative risk that arises from the most suitable vector for a cell. All models include variable anthrophilicity of vectors and spatial variation in human population density. Relative risk maps are produced from these models. All models predict that human population density is the critical factor determining malaria risk. Our method of constructing relative risk maps is equally general. We discuss the limits of the relative risk maps reported here, and the additional data that are required for their improvement. The protocol developed here can be used for any other vector-borne disease