Determination of eligibility to antiretroviral therapy in resource limited settings using total lymphocyte counts, hemoglobin and body mass index among HIV positive patients

Background: Acquired Immunodeficiency Syndrome is a serious public health problem in Ethiopia. CD4+ T cell count testing is the standard method for determining eligibility for antiretroviral therapy. However, automation for CD4+ T cell count is not widely available in sub-Saharan Africa including Ethiopia.Objective: This study was to determine eligibility for antiretroviral therapy in resource-limited settings using total lymphocyte counts, hemoglobin and body mass index among HIV positive patients.Materials and methods: CD4+ T cell count was determined using Becton Dickinson FACS count analyzer. Total lymphocyte count and hemoglobin concentration were measured by a Cell Dyne 1800 hematology analyzer and body mass index was determined. Correlation of total lymphocyte count, hemoglobin and body mass index with CD4+ T cell count was determined by Pearson’s correlation coefficient and p-value.Results: The correlation between CD4+ T cell count and Total Lymphocyte Count (TLC) was not strong, but the association between CD4+ T cell count and TLC was highly significant and correlation between CD4+ T cell counts with hemoglobin were very weak. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of TLC using threshold value of 1000 cells/mm3 for CD4+ T cell counts <350 cells/mm3 were 3% , 94%, 17% and 71%, respectively. Total lymphocyte count threshold of 1750 cells/mm3 were the better predictor of CD4+ T cell counts of <350 cells/mm3 when compared to < 200 cells/mm3.Conclusion: TLC showed weak correlation with CD4+ T cell counts but the association between CD4+ T cell count with TLC was significant (p<0.0001). The TLC threshold of 1750 cells/mm3 were the most accurate predictors of CD4+ T cell counts of <350 cells/mm3. Therefore, the significant association of TLC with CD4+ T cell count may suggest that TLC could be used as marker for CD4+ T cell count in determining anti-retroviral treatment initiation when CD4+ T cell count is not available particularly in rural settings where laboratory facilities are lacking

Kinetic versus Magnetic Chaos in Toroidal Plasmas: A systematic quantitative comparison

Magnetic field line chaos occurs under the presence of non-axisymmetric perturbations of an axisymmetric equilibrium and is manifested by the destruction of smooth flux surfaces formed by the field lines. These perturbations also render the particle motion, as described by the guiding center dynamics, non-integrable and, therefore, chaotic. However, the chaoticities of the magnetic field lines and the particle orbits significantly differ both in strength and radial location in a toroidal configuration, except for the case of very low-energy particles whose orbits closely follow the magnetic field lines. The chaoticity of more energetic particles, undergoing large drifts with respect to the magnetic field lines, crucially determines the confinement properties of a toroidal device but cannot be inferred from that of the underlying magnetic field. In this work, we implement the Smaller ALignment Index (SALI) method for detecting and quantifying chaos, allowing for a systematic comparison between magnetic and kinetic chaos. The efficient quantification of chaos enables the assignment of a value characterizing the chaoticity of each orbit in the space of the three constants of the motion, namely energy, magnetic moment and toroidal momentum. The respective diagrams provide a unique overview of the different effects of a specific set of perturbations on the entire range of trapped and passing particles, as well as the radial location of the chaotic regions, offering a valuable tool for the study of particle energy and momentum transport and confinement properties of a toroidal fusion device.Comment: 27 pages, 7 figure

An exploration of family quality of life in persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities and their family members in Ethiopia

BACKGROUND: Leprosy, podoconiosis and lymphatic filariasis (LF) may adversely affect the social, economic and psychological well-being of persons affected and their families. The objectives of this study were to assess and compare family quality of life of persons affected and their family members, explore the relationship between family quality of life and perceived stigma and activity limitations and explore what factors influence family quality of life. METHODS: A cross-sectional quantitative study was conducted in the Awi zone in Ethiopia. Persons affected and their family members were selected using purposive sampling. Three questionnaires were used: the Beach Center Family Quality of Life (FQOL) scale (range 25-125, with higher scores denoting higher family quality of life), the SARI Stigma Scale (range 0-63, with higher scores denoting higher levels of stigma) and the Screening of Activity Limitation and Safety Awareness (SALSA) scale (range 0-80, with higher scores denoting more activity limitations). Data analysis consisted of simple descriptive analysis and regression analysis. RESULTS: A total of 95 persons affected and 117 family members were included. The overall mean of the family quality of life score was 71.7. Persons affected had significantly higher mean family quality of life scores than family members on all domains. Female gender, a smaller family size and occupation were associated with lower family quality of life. We found a mean SARI Stigma score of 22.3 and a mean SALSA score of 37.6. There was no association between the FQOL and SARI scores or between

Forest and landscape restoration opportunities in the western catchment of Lake Ziway, Central Rift Valley, Ethiopia: technical report

Forest and landscape restoration measures could address landscape degradation, increase ecosystem services, and improve livelihoods. However, mapping potential areas for forest and landscape restoration measures and identifying enabling and constraining factors is crucial for effective implementation. This study was conducted in the western catchment of Lake Ziway, Central Rift Valley, Ethiopia, to identify potential forest and landscape restoration options, map potential areas, assess the benefits and cost of options, and investigate success and failure factors for implementing interventions. The study adopted the Restoration Opportunities Assessment Methodology (ROAM), which enables selecting and mapping forest and landscape restoration options. Data were collected using field surveys, key informant interviews, focus group discussion and literature reviews. We also employed GIS and remote sensing methods to characterize the long-term land use and land-cover dynamics and changes in the status of land degradation. Cost–benefit analysis was conducted to assess the economic viability of identified restoration options. The results suggested that over the last 20 years (2002 to 2022), the western catchment of Lake Ziway experienced severe forest and landscape degradation due to anthropogenic and climatic factors, resulting in multiple environmental and socioeconomic consequences. This study identified seven context-specific forest and landscape restoration measures to address the problem. They vary in cost, trajectory and specific economic and social outcomes. Most options were economically viable with additional environmental and social benefits. For example, the benefit of carbon sequestration for home garden agroforestry was estimated at USD 27,032.5 ha-1 over 20 years. It was also found that a considerable portion of the catchment area was potentially suitable for agroforestry practices (40%), particularly for scattered trees on farmlands. However, the potential areas suitable for full afforestation or reforestation and tree buffers are smaller (6%). Integrating multiple forest and landscape restoration measures in the catchment could maximize the environmental and socioeconomic outcomes. Opportunities to effectively implement and scale up the identified forest and landscape restoration options include the availability of adequate active labor, the diverse benefits of measures, and the existence of supporting policies and strategies, multiple potential financing mechanisms and active development of governmental and non-governmental organizations. However, the absence of guidelines for implementing legal issues, weak coordination among responsible institutions, and inadequate finance and incentives have been identified as major constraints to scale up forest and landscape restoration measures. The findings of this study may serve as a guide for the planning, design and implementation of restoration measures in the study catchment and similar future projects in other catchments

Undernutrition among Ethiopian adults living with HIV: a meta-analysis.

BackgroundMalnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia.MethodsWe searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I 2 test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults.ResultsAfter reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%).ConclusionThis study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm3, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement

Exploring temporality in socio-ecological resilience through experiences of the 2015–16 El Niño across the Tropics

In a context of both long-term climatic changes and short-term climatic shocks, temporal dynamics profoundly influence ecosystems and societies. In low income contexts in the Tropics, where both exposure and vulnerability to climatic fluctuations is high, the frequency, duration, and trends in these fluctuations are important determinants of socio-ecological resilience. In this paper, the dynamics of six diverse socio-ecological systems (SES) across the Tropics – ranging from agricultural and horticultural systems in Africa and Oceania to managed forests in South East Asia and coastal systems in South America – are examined in relation to the 2015–16 El Niño, and the longer context of climatic variability in which this short-term ‘event’ occurred. In each case, details of the socio-ecological characteristics of the systems and the climate phenomena experienced during the El Niño event are described and reflections on the observed impacts of, and responses to it are presented. Drawing on these cases, we argue that SES resilience (or lack of) is, in part, a product of both long-term historical trends, as well as short-term shocks within this history. Political and economic lock-ins and dependencies, and the memory and social learning that originates from past experience, all contribute to contemporary system resilience. We propose that the experiences of climate shocks can provide a window of insight into future ecosystem responses and, when combined with historical perspectives and learning from multiple contexts and cases, can be an important foundation for efforts to build appropriate long-term resilience strategies to mediate impacts of changing and uncertain climates

Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection

Background: Nitric oxide (NO) is essential for host defense in rodents, but the role of NO during tuberculosis (TB) in man remains controversial. However, earlier observations that arginine supplementation facilitates anti-TB treatment, supports the hypothesis that NO is important in the host defense against TB. Local production of NO measured in fractional exhaled air (FeNO) in TB patients with and without HIV co-infection has not been reported previously. Thus, our aim was to investigate levels of FeNO in relation to clinical symptoms and urinary NO metabolites (uNO). Methods: In a cross sectional study, FeNO and uNO were measured and clinical symptoms, chest x-ray, together with serum levels of arginine, tumor necrosis factor alpha (TNF-alpha) and interleukin 12 (IL-12) were evaluated in sputum smear positive TB patients (HIV+/TB, n = 36, HIV-/TB, n = 59), their household contacts (n = 17) and blood donors (n = 46) from Gondar University Hospital, Ethiopia. Results: The proportion of HIV-/TB patients with an increased FeNO level (> 25 ppb) was significantly higher as compared to HIV+/TB patients, but HIV+/TB patients had significantly higher uNO than HIV-/TB patients. HIV+ and HIV-/TB patients both had lower levels of FeNO compared to blood donors and household contacts. The highest levels of both uNO and FeNO were found in household contacts. Less advanced findings on chest x-ray, as well as higher sedimentation rate were observed in HIV+/TB patients as compared to HIV-/TB patients. However, no significant correlation was found between FeNO and uNO, chest x-ray grading, clinical symptoms, TNF-alpha, IL-12, arginine levels or sedimentation rate. Conclusion: In both HIV negative and HIV co infected TB patients, low levels of exhaled NO compared to blood donors and household were observed. Future studies are needed to confirm whether low levels of exhaled NO could be a risk factor in acquiring TB and the relative importance of NO in human TB.Original Publication: Jonna Idh, Anna Westman, Daniel Elias, Feleke Moges, Assefa Getachew, Aschalew Gelaw, Tommy Sundqvist, Tony Forslund, Addis Alemu, Belete Ayele, Ermias Diro, Endalkachew Melese, Yared Wondmikun, Sven Britton, Olle Stendahl and Thomas Schoen, Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection, 2008, BMC INFECTIOUS DISEASES, (8), 146. http://dx.doi.org/10.1186/1471-2334-8-146 Publisher: BioMed Central http://www.biomedcentral.com