Cutaneous leishmaniasis a neglected tropical disease: community knowledge, attitude and practices in an endemic area, Northwest Ethiopia

Abstract Background Cutaneous leishmaniasis is one of the neglected tropical diseases in the Ethiopian highlands and studies on assessment of knowledge, attitude and practice of the community in endemic areas are scanty. The study aimed to assess the knowledge, attitude towards cutaneous leishmaniasis and treatment seeking practices in people living in the endemic highlands areas in the Northwest, Ethiopia and to provide evidence-based information to guide development of appropriate interventions to reduce the impact of cutaneous leishmaniasis on communities. Methods Quantitative cross-sectional study was conducted in cutaneous leishmaniasis endemic districts (woredas) using a semi structured questionnaire. Households were randomly selected according to probability proportional to size of households in each enumeration area. Systematic random sampling of eligible households was based on the number of households recorded during listing of households. Descriptive statistics was used to describe numerical data, organise and summarise the data in a manner that gave meaning to the numerical form. Frequency tables were used to show descriptive analysis and regression analysis was used to determine correlation between variables. Results Majority of respondents 321(78.7%) lived in rural areas, age ranged between 18 and 85 years and most were farmers. Illiteracy was high (47.6%) among respondents and majority 358(87.8%) had seen patients with CL. Less than quarter (21.6%) had heard about sand flies and knowledge on the peak transmission period was low (46.3%). About 192 (47.1%) of the respondents indicated disfiguring lesions were the major clinical presentations, less than half 55(27.5%) of urban residents believed CL was treatable compared to 145(72.5%) of rural residents (P < 0.001). Traditional medicines were indicated as best treatment option by 209(51.2%) compared to 114(27.9%) for modern treatment. Major factors influencing treatment options included accessibility to treatment facilities, distance and short duration of treatment. Participants expressed negative experiential attitude and perceived control towards modern treatment because of inaccessibility and distance from where modern treatment is provided. Conclusion Priority should be given to primary prevention and appropriate awareness campaigns on lesion recognition. Information on modern treatment should be intensified

Intention toward condom use and its associated factors among students of Debre Work Senior Secondary and Preparatory School, East Gojjam Zone, Amhara Region, Ethiopia

Objective: The main aim of this research was to investigate the students’ intention toward condom use and associated factors among students in Debre Work Secondary and Preparatory School, 2015. Methods: A survey was carried out in the high school and the preparatory school. The selfadministered semistructured questionnaire was distributed to 422 students. Systematic sampling techniques were employed to each class. Data were entered and analyzed by using SPSS version 20.0 software. Descriptive and analytical data analysis and presentation were used. Logistic regression model was used to check independent associations. Result: Most (80.8%) of the respondents were not married. More than half (53.0% and 52.3%) of the respondents had low perceived benefit and low perceived self-efficacy of using condom. About 46.79% of respondents had an interest in using condoms and the rest had no intention. Males were 1.96 times more likely to have intention to use condom compared to females (adjusted odds ratio [AOR], 95% confidence interval [CI] 1.96 [1.29, 2.99]). When the intention to use condoms was compared, married respondents were 2.41 times more likely than those who were not married (AOR, 95% CI 2.41 [1.41, 4.14]). Intention to use condoms among respondents who had high perceived benefit of using condom were 1.57 times more compared to those who had low perceived benefit of using condom (AOR, 95% CI 1.57 [1.03, 2.39]). Intention to use condoms among those who had high perceived self-efficacy on condom use was 4.37 times higher compared to those who had low perceived self-efficacy (AOR, 95% CI 4.37 [2.85, 6.71]). Conclusion: The level of intention to use condoms among students of Debre Work Senior Secondary and Preparatory School was low. Sex, current marital status, perceived benefit of using condom, and perceived self-efficacy on condom use were the most positive contributing factors for intention to condom use.Habtamu Abera, Fanta Tamiru, Getiye Dejenu Kibre

Population Based Survey of Chronic Non-Communicable Diseases at Gilgel Gibe Field Research Center, Southwest Ethiopia

BACKGROUND: Chronic Non-communicable Diseases are increasingly becoming more prevalent and burden to the health care system in developing countries including Ethiopia. However, evidences showing the magnitude of the problem in those countries are scarce particularly in a community setting.The objective of this study was to determine the magnitude of chronic non communicable diseases in a community.METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center from late September 2008 to end of January 2009. A random sample of 4,469 individuals aged 15-64 years was studied. Data on characteristics and chronic symptom inventories were collected by interviewing study participants. Blood pressure was taken three times from each individual and blood sugar and lipid levels were determined after an overnight fasting. Data were analyzed using SPSS for Windows version 16.0 and STATA 11.RESULTS: The overall prevalence of CNCD was 8.9% (7.8% men and 9.8% women). The specific observed prevalence were 0.5% for diabetes mellitus (DM), 2.6% for hypertension, 3.0% for cardiovascular diseases, 1.5% for asthma and 2.7% for mental illness. In addition 3.1% and 9.3% of the study population had been informed to have DM and hypertension respectively.CONCLUSION: There is a high prevalence of CNCD among the study population indicating an immediate need for preventive action and also warrant further nationally representative study.Keywords: CNCD, Non-communicable, Prevalence, Southwest Ethiopi

Podoconiosis in East and West Gojam Zones, Northern Ethiopia

Background: Podoconiosis is a neglected tropical disease (NTD) that is prevalent in red clay soil-covered highlands of tropical Africa, Central and South America, and northern India. It is estimated that up to one million cases exist in Ethiopia. This study aimed to estimate the prevalence of podoconiosis in East and West Gojam Zones of Amhara Region in northern Ethiopia. Methodology/Principal Findings: A cross-sectional household survey was conducted in Debre Eliyas and Dembecha woredas (districts) in East and West Gojam Zones, respectively. The survey covered all 17,553 households in 20 kebeles (administrative subunits) randomly selected from the two woredas. A detailed structured interview was conducted on 1,704 cases of podoconiosis identified in the survey. Results: The prevalence of podoconiosis in the population aged 15 years and above was found to be 3.3% (95% CI, 3.2% to 3.6%). 87% of cases were in the economically active age group (15–64 years). On average, patients sought treatment five years after the start of the leg swelling. Most subjects had second (42.7%) or third (36.1%) clinical stage disease, 97.9% had mossy lesions, and 53% had open wounds. On average, patients had five episodes of acute adenolymphangitis (ALA) per year and spent a total of 90 days per year with ALA. The median age of first use of shoes and socks were 22 and 23 years, respectively. More men than women owned more than one pair of shoes (61.1% vs. 50.5%; x2 = 11.6 p = 0.001). At the time of interview, 23.6% of the respondents were barefoot, of whom about two-thirds were women. Conclusions: This study showed high prevalence of podoconiosis and associated morbidities such as ALA, mossy lesions and open wounds in northern Ethiopia. Predominance of cases at early clinical stage of podoconiosis indicates the potential for reversing the swelling and calls for disease prevention interventions

Bioactive Volatiles From Push-Pull Companion Crops Repel Fall Armyworm and Attract Its Parasitoids

Fall armyworm, Spodoptera frugiperda, is a serious invasive pest in Africa but "Push-Pull" companion cropping can substantially reduce infestation. Here, we elucidate the underpinning chemical ecology mechanisms. We hypothesized that companion crop volatiles repel herbivores (push) while attracting natural enemies (pull). Headspace volatiles collected from companion plants (Desmodium intortum, Desmodium uncinatum, Brachiaria Mulato II) were used in bioassays and electrophysiological recordings with S. frugiperda and parasitoid wasps. Insect populations, plant damage and herbivore parasitism were assessed in field plots. Coupled GC-electroantennogram (GC-EAG) recordings showed robust responses to certain aromatic and terpenoid volatile compounds. In wind tunnel bioassays, maize volatiles mixed with Desmodium volatiles were less attractive to moths than maize alone. In oviposition bioassays, S. frugiperda laid significantly fewer eggs on maize when Desmodium volatiles were present. Conversely, in an olfactometer bioassay, parasitoid wasps were attracted to the scent of both Desmodium spp. (intercrop) and the Brachiaria border crop. Our data provide evidence of the mechanisms underpinning reduced S. frugiperda infestation in the Push-Pull companion cropping system, i.e., volatiles from companion crops repel S. frugiperda while attracting its parasitoid natural enemies. These findings explain why Push-Pull field plots had fewer S. frugiperda larvae and lower crop damage than monocropped maize

Exploiting thrips aggregation pheromones to develop a lure-and-kill strategy for the management of the bean flower thrips

The potential of semiochemicals to lure insect pests to a trap where they can be killed with biopesticides has been demonstrated as an eco-friendly pest management alternative. In this study, we tested two recently characterized male-produced aggregation pheromones of the bean flower thrips Megalurothrips sjostedti (Trybom), namely (R)-lavandulyl 3-methylbutanoate (major) and (R)-lavandulol (minor), for their field efficacy. Moreover, compatibility of these pheromones and two other thrips attractants, Lurem-TR and neryl (S)-2-methylbutanoate, with the entomopathogenic fungus (EPF) Metarhizium anisopliae ICIPE 69 has been determined. Our study revealed that the M. sjostedti aggregation pheromones have dose-dependent antifungal effects on the EPF viability, but showed no fungistatic effect at a field-realistic dose for attraction of thrips. (R)-lavandulyl 3-methylbutanoate had similar antifungal effects as neryl (S)-2-methylbutanoate 8 days after exposure; whereas, Lurem-TR had a stronger antifungal effect than other thrips attractants. In the semi-field experiments, all autoinoculation devices maintained at least 86% viability of M. anisopliae conidia after 12 days of exposure. Field trials demonstrated for the first time that (R)-lavandulyl 3-methylbutanoate increases trap catches. Our findings pave a way for designing a lure-and-kill thrips management strategy to control bean flower thrips using autoinoculation devices or spot spray application

Patients' perceptions of podoconiosis causes, prevention and consequences in East and West Gojam, Northern Ethiopia

BACKGROUND Podoconiosis is a form of non-filarial elephantiasis that affects barefoot individuals in highland tropical areas. The disease presents with bilateral, asymmetric swelling of the legs, usually confined to below the knee. This study aimed to assess podoconiosis patients' perceptions of prevention, control, causes and familial clustering of the disease, and to document physical, social and economic impairments associated with the disease, with the ultimate aim of enabling development of tailored interventions in this region. METHODS This descriptive study is part of the largest cross-sectional community-based household survey yet conducted on podoconiosis. It was completed in November and December, 2011, in Debre Eliyas and Dembecha Woredas of East and West Gojam Zones, northern Ethiopia, and consisted of a house-to-house census by community health workers followed by interviews of identified patients using a structured questionnaire. RESULTS In the 17,553 households surveyed, 1,319 patients were identified. More male as compared to female patients were married (84.6% vs. 53.6%, χ(2) = 157.1, p < 0.0001) while more female as compared to male patients were divorced (22.5% vs. 3.6%, χ(2) = 102.3, p < 0.0001). Less than half of the study subjects believed podoconiosis could be prevented (37.5%) or controlled (40.4%) and many (41.3%) did not know the cause of podoconiosis. Two-fifths of the study subjects had a relative affected with podoconiosis. Approximately 13% of the respondents had experienced one or more forms of social stigmatization. The coping strategies adopted by patients to mitigate the physical impairments caused by podoconiosis were: working only occasionally (44.9%), avoiding physically demanding tasks (32.4%), working fewer hours (21.9%) or completely stopping work (8%). Most study subjects (96.4%) had noticed a decline in their income following the development of podoconiosis, and 78% said they were poorer than their healthy neighbours. CONCLUSION This study shows that podoconiosis has strong psychosocial, physical and economic impacts on patients in East and West Gojam Zones of northern Ethiopia. Concerns related to familial clustering, poor understanding of the causes and prevention of podoconiosis all add to the physical burden imposed by the disease. Strategies that may ease the impact of podoconiosis include delivery of tailored health education on the causes and prevention of disease, involving patients in intervention activities, and development of alternative income-generating activities for treated patients

Mortality and Disability-adjusted Life-years (DALYs) for common neglected tropical Diseases in Ethiopia, 1990 to 2015: evidence from the Global Burden of Disease Study 2015

Introduction: Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. Methods: We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), malaria indicator surveys (MICS) and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate malaria and NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). Results: All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699 – 10,080) in 1990 and 3,593 deaths (95% UI: 2051 – 6178) in 2015, a 70% reduction over the 25 years. Age-standardised mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand–1.2 million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand – 1.3 million) in 2015. Age-standardised DALY rates due to all NTDs declined by 30.4%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 – 27.4) in 2015. Age-standardised DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 – 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4 – 59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardised DALY rates for onchocerciasis, schistosomiasis and lymphiatic filariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. Conclusions: Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020

Using qualitative methods to explore lay explanatory models, health-seeking behaviours and self-care practices of podoconiosis patients in north-west Ethiopia

Background: Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care. Methods: In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia. Results: Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue. Conclusion: A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care