Sero-Epidemiology of Foot and Mouth Disease in Domestic Ruminants in Amhara Region, Ethiopia

This study involved cross-sectional serological and questionnaire-based surveys to investigate the sero-epidemiology of foot and mouth disease (FMD) in domestic ruminants, and farmers' knowledge and practices about the disease in the Amhara region of Ethiopia. A multistage cluster sampling was carried out to select domestic ruminants for serological sampling and for the interview with farmers. A total of 1,672 sera samples were collected and tested using a 3ABC-Enzyme Linked Immunosorbent Assay, and 170 farmers were interviewed. An overall FMD apparent seroprevalence of 11.48% (95% CI: 7.52–17.14%) was recorded in the domestic ruminants. The overall true prevalence was 12.04%. The seroprevalence of FMD was higher in cattle (14.37%) than in goats (7.10%) and sheep (7.07%). The age stratified seroprevalence in the districts showed that 66.67% of the districts studied experienced a FMD outbreak within the preceding year of the study time. A mixed effect logistic regression analysis revealed that agroecology, the production system and the age of the animal was significantly associated with FMD seropositivity in cattle (P < 0.05). A statistically significant (P < 0.05) positive correlation (r = 0.93) was observed between cattle and small ruminant FMD seroprevalences. About 82% of the farmers interviewed knew of FMD and 85% of them had experienced the disease in their own herds before. The farmers mostly employ traditional means to control FMD. In conclusion, the findings of the study indicated that FMD is a prevalent disease in the Amhara region with more importance in the intensive production systems and the lowlands of the region. High correlation in seroprevalence between small and large ruminants indicated a possible cross transmission between these species. Therefore, small ruminants should not be overlooked in FMD control. Farmers in the region have a good level of knowledge about the disease; however, currently they heavily rely on traditional practices primarily focused on treating wounds of infected animals. This calls for extension work on available effective preventive measures of the disease, such as vaccination and movement restriction

Harnessing data science to improve integrated management of invasive pest species across Africa: An application to Fall armyworm (Spodoptera frugiperda) (J.E. Smith) (Lepidoptera: Noctuidae)

After five years of its first report on the African continent, Fall armyworm (FAW), Spodoptera frugiperda (J.E. Smith) is considered a major threat to maize, sorghum, and millet production in sub-Saharan Africa. Despite the rigorous work already conducted to reduce FAW prevalence, the dynamics and invasion mechanisms of FAW in Africa are still poorly understood. This study applied interdisciplinary tools, analytics, and algorithms on a FAW dataset with a spatial lens to provide insights and project the intensity of FAW infestation across Africa. The data collected between January 2018 and December 2020 in selected locations were matched with the monthly average data of the climatic and environmental variables. The multilevel analytics aimed to identify the key factors that influence the dynamics of spatial and temporal pest density and occurrence at a 2 km x 2 km grid resolution. The seasonal variations of the identified factors and dynamics were used to calibrate rule-based analytics employed to simulate the monthly densities and occurrence of the FAW for the years 2018, 2019, and 2020. Three FAW density level classes were inferred, i.e., low (0–10 FAW moth per trap), moderate (11–30 FAW moth per trap), and high (>30 FAW moth per trap). Results show that monthly density projections were sensitive to the type of FAW host vegetation and the seasonal variability of climatic factors. Moreover, the diversity in the climate patterns and cropping systems across the African sub-regions are considered the main drivers of FAW abundance and variation. An optimum overall accuracy of 53% was obtained across the three years and at a continental scale, however, a gradual increase in prediction accuracy was observed among the years, with 2020 predictions providing accuracies greater than 70%. Apart from the low amount of data in 2018 and 2019, the average level of accuracy obtained could also be explained by the non-inclusion of data related to certain key factors such as the influence of natural enemies (predators, parasitoids, and pathogens) into the analysis. Further detailed data on the occurrence and efficiency of FAW natural enemies in the region may help to complete the tri-trophic interactions between the host plants, pests, and beneficial organisms. Nevertheless, the tool developed in this study provides a framework for field monitoring of FAW in Africa that may be a basis for a future decision support system (DSS).Harnessing data science to improve integrated management of invasive pest species across Africa: An application to Fall armyworm (Spodoptera frugiperda) (J.E. Smith) (Lepidoptera: Noctuidae)publishedVersio

Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study

BackgroundProphylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices.AimThis study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH).MethodsThe observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach.ResultSurgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds.ConclusionDeeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments. Methods: Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body-mass index. All of the estimates were reported as counts and age-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates. Findings: In 2017, there were 448 000 (95% UI 439 000\u2013456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000\u2013221 000; 51\ub79%) were in males. The age-standardised incidence rate was 5\ub70 (4\ub79\u20135\ub71) per 100 000 person-years in 1990 and increased to 5\ub77 (5\ub76\u20135\ub78) per 100 000 person-years in 2017. There was a 2\ub73 times increase in number of deaths for both sexes from 196 000 (193 000\u2013200 000) in 1990 to 441 000 (433 000\u2013449 000) in 2017. There was a 2\ub71 times increase in DALYs due to pancreatic cancer, increasing from 4\ub74 million (4\ub73\u20134\ub75) in 1990 to 9\ub71 million (8\ub79\u20139\ub73) in 2017. The age-standardised death rate of pancreatic cancer was highest in the high-income super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17\ub74 [15\ub78\u201319\ub70] per 100 000 person-years) and Uruguay (12\ub71 [10\ub79\u201313\ub75] per 100 000 person-years). These countries also had the highest age-standardised death rates in 1990. Bangladesh (1\ub79 [1\ub75\u20132\ub73] per 100 000 person-years) had the lowest rate in 2017, and S\ue3o Tom\ue9 and Pr\uedncipe (1\ub73 [1\ub71\u20131\ub75] per 100 000 person-years) had the lowest rate in 1990. The numbers of incident cases and deaths peaked at the ages of 65\u201369 years for males and at 75\u201379 years for females. Age-standardised pancreatic cancer deaths worldwide were primarily attributable to smoking (21\ub71% [18\ub78\u201323\ub77]), high fasting plasma glucose (8\ub79% [2\ub71\u201319\ub74]), and high body-mass index (6\ub72% [2\ub75\u201311\ub74]) in 2017. Interpretation: Globally, the number of deaths, incident cases, and DALYs caused by pancreatic cancer has more than doubled from 1990 to 2017. The increase in incidence of pancreatic cancer is likely to continue as the population ages. Prevention strategies should focus on modifiable risk factors. Development of screening programmes for early detection and more effective treatment strategies for pancreatic cancer are needed. Funding: Bill & Melinda Gates Foundation

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented

Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundatio