Review on Recent Major Diagnostic Methods: The Diagnostic of Methicillin Resistant Staphylococcus Aurus

According to the World Health Organization (WHO) 20% of all documented S. aureus infections are attributable to methicillin resistant staphylococcus aureus (MRSA), although for some developing countries this value can exceed 80%. Thus the rapid and accurate detection of MRSA in low resource settings is becoming essential. Yet conventional microbial detection methods take from 1-5 days to identify MRSA. Recently, new types of automated laboratory methods as well as advances in nucleic acid testing, microfluidic technology, immunosensors, biosensors and point of care testing have reduced the time to detection to <1 hr. This review examines the current limitations and advances in methodologies employed in the rapid detection of MRSA. Keywords: S.aureus, MRSA, Pathogenesis, Diagnosis DOI: 10.7176/JBAH/11-2-03 Publication date: January 31st 202

Measuring and modelling service quality in Ethiopian public higher education

This study serves two major purposes. First, it explores and validates attributes, dimensions and constructs that can be used to measure service quality in Ethiopian public higher education (EPHE) context. Second, it examines the interplay among the major service quality constructs and student related variables in search of a comprehensive theoretical framework for HE service quality. The study started its investigation by formulating a set of research questions that explore attributes, dimensions and constructs essential to measure service quality (RQ1), test for the measurement model fit (RQ2), examine the relationships or associations among the four service constructs and characteristics of students (RQ3), test for the structural model fit (RQ4), determine the causal relations among the variables in the structural model (RQs4.1 - 4.7), and assess service quality performances of EPHE institutions (RQ5). A mixed methods study with the qual-QUAN exploratory sequential design was employed to empirically answer the research questions. Fifteen interviewees took part in the qualitative phase. The interviews were analysed employing thematic analysis and narration of verbatim accounts. Three levels of themes that represent attributes, dimensions and constructs of service quality were identified and used to develop a questionnaire designed to measure service quality more objectively. The questionnaire was piloted at a pilot site involving 460 undergraduate students and its psychometric properties were determined. The main study was carried out in three universities selected from a target population of seven first generation public universities employing lottery sampling method. Concurrently, four programmes were chosen from a target population of 27 commonly offered programmes in the three sample universities employing systematic random sampling. Considering different batches and the four programmes as strata, 1412 undergraduate students were included in the main study using proportionate stratified random sampling technique. Descriptive and inferential statistics including factor analysis and structural equation modelling (SEM) were employed to address the research questions. The results from the qualitative and quantitative phases show that service quality can be measured by four constructs, of which three are multi-dimensional and one is a single dimensional construct. The four factor measurement model fit analysis resulted in an acceptable fit indices (i.e., CMIN/DF = 4.398, GFI = .915, CFI = .951, RMSEA = .049 and PCLOSE =.743) after some re-specifications and confirmed the structural validity of the instrument. Mixed results were obtained with regard to the correlations/associations between student characteristics and service quality constructs. After some re-specification, a structural model for the four service quality constructs and nine student related variables were identified with an acceptable fit indices (CMIN/DF=3.856, GFI=.901, CFI =.934 and RMSEA=.045, p=1.000). The path analyses also revealed that loyalty is a latent construct with 62% of its varaince predicted by the joint effects of percieved service quality, satisfaction and perceived gain. Each of these predicator latent constructs are also explained by some other control varaibles and latent constructs that have a predictive power ranging from 12% to 60%. Students perceived the current status of service quality in EPHE institutions as daunting in all constructs of service quality except perceived gain. Finally, conclusions pertinent to the measurement instrument and understanding of HE service queality are drawn, and recommendations that have theoretical and practical implications are forwarded.Educational Leadership and ManagementD. Ed. (Education Management

The Impact of Wetland Degradation and Conversion on Socioeconomic Values: The Case of Amhara National Regional State Tekuma Wetland, Lake Tana Sub-Basin, Ethiopia

Wetlands provide flood and erosion control, providing economic and social benefits to communities living around the wetlands (Yilma Delelegn and Geheb, 2003). Although wetlands have many known characteristics that are important to the livelihoods of local inhabitants, they are degraded and lost due to a lot of triggering factors. Similar to other wetlands in the country, Tekuma wetland has been affected by different factors. Wetlands and their value remain little understood and their loss is increasingly becoming an environmental disaster (Yilma Delelegn and Geheb, 2003). Thus, a study was conducted in Tekuma wetland, south western part of Lake Tana in Ethiopia to investigate the impacts of the loss of wetland on socioeconomic values. In order to select the research site and respondents, purposive and simple random sampling techniques were applied. Socioeconomic data, collected using structured questionnaire, were analyzed using descriptive statistics, paired and one sample t-test techniques. The analysis of the result showed that major land use change has occurred from 1999 to 2008 followed by 1989 to 1998. Among the triggering factors for the loss of wetland direct conversion of wetlands to cultivated land was considered to be extremely high followed by overgrazing and vegetation clearance. Although Tekuma wetland has been providing different socioeconomic and ecosystem benefits to the society, the benefits of Tekuma wetland as a source of water was considered great, which has significantly improved the livelihood of the community. As the level of wetland degradation increases their benefit is reduced. As to the local people, if Tekuma wetland is lost the whole benefits that have improved their livelihood through irrigated agriculture will be lost. Hence, government has to provide special attention to minimize the loss/conversion of wetlands and maximize their socioeconomic and ecosystem benefits

Intra-Abdominal Hydatid Cyst: Sociodemographics, Clinical Profiles, and Outcomes of Patients Operated on at a Tertiary Hospital in Addis Ababa, Ethiopia

Background. Hydatid cyst is caused by the tapeworm Echinococcus granulosus. The abdomen, specifically the liver, is the most common site affected. Objective. Determine the presentation patterns, types of surgical management, and outcomes of patients operated for intra-abdominal hydatid cyst (IAHC). Methodology. A retrospective descriptive study of patients admitted and operated for IAHC from September 1, 2011, to August 31, 2015. Results. Forty-two patients whose age ranged from 10 to 65 (mean of 37 years) were operated on. Females comprised 27 (64.3%) of the patients. The commonest presenting complaint was abdominal pain (41, 97.6%). Abdominal mass was documented in 23 (54.7%) cases. Abdominal ultrasound (AUS) and CT were the main imaging studies done on 38 (90.5%) and 24 (57.1%) patients, respectively. Cysts measuring more than 10 cm in diameter were the most common finding in both studies. Liver was the primary site involved, 30 (71.4%) cases, the right lobe being the main side, 73%. Thirty-eight (90.5%) patients underwent deroofing, evacuation, marsupialization, and omentoplasty (DEMO). There was no perioperative death, but 4 (9.5%) of the patients had post-op complications. Conclusion. Abdominal pain was the most common presenting complaint. AUS and CT remain the preferred imaging. DEMO was the most common surgery

Effect of Wetland Degradation and Conversion on Carbon Stock: The Case of Tekuma Wetland, Lake Tana Sub-Basin, Ethiopia

Wetlands are considered as one of the major carbon sinkers that have significant positive effect on reducing the impact of climate change. However, the contribution of wetland to climate change mitigation through carbon sequestration is not well understood by the public. Many developed and developing countries signed in and supported the inclusion of agriculture and wetland projects in the Kyoto Protocol. But Ethiopian government has not yet tried to take advantage of this opportunity and start negotiations to use conservation and improvement of wetland’s carbon sequestration potential in the country to obtain carbon funds as an economic incentive for the communities involved. With this background, this research was designed to carry out an in-depth study on the impact of wetland degradation and conversion on carbon sequestration potential in Ethiopia. To meet the stated objectives stratified sampling techniques were used to select sampling sites from the wetland areas having varying wetland degradation level. For the determination of carbon levels in each area replicates of plant and soil samples were collected. The plant organic matter was determined using a loss-on-ignition method and then converted to carbon stock. Carbon stock and bulk density of the sampled soil was determined using Walkely-Black oxidation and gravimetric methods, respectively. ANOVA and mean separation were computed to indicate whether there is significant difference in carbon stock due to wetland degradation. The research findings showed significant difference (P<0.05) of carbon storage with different wetland degradation levels. Carbon stock in the soil was on average 24 times higher than carbon stock in plants in each respective wetland area having varying degradation level. The intact wetland was able to sequester579 t/ha of CO2as compared to converted farmlands and grazing lands that had only 230 and 295 t/ha of CO2, respectively. The result showed that by protecting wetlands more than double carbon could be stored as compared to grazing and farmlands. Thus, it is recommended that special attention should be given to minimize the conversion of wetlands and maximize their benefits through carbon funding

Spatiotemporal distribution and bionomics of Anopheles stephensi in different eco-epidemiological settings in Ethiopia

Background: Malaria is a major public health concern in Ethiopia, and its incidence could worsen with the spread of the invasive mosquito species Anopheles stephensi in the country. This study aimed to provide updates on the distribution of An. stephensi and likely household exposure in Ethiopia. Methods: Entomological surveillance was performed in 26 urban settings in Ethiopia from 2021 to 2023. A kilometer-by-kilometer quadrant was established per town, and approximately 20 structures per quadrant were surveyed every 3 months. Additional extensive sampling was conducted in 50 randomly selected structures in four urban centers in 2022 and 2023 to assess households’ exposure to An. stephensi. Prokopack aspirators and CDC light traps were used to collect adult mosquitoes, and standard dippers were used to collect immature stages. The collected mosquitoes were identified to species level by morphological keys and molecular methods. PCR assays were used to assess Plasmodium infection and mosquito blood meal source. Results: Catches of adult An. stephensi were generally low (mean: 0.15 per trap), with eight positive sites among the 26 surveyed. This mosquito species was reported for the first time in Assosa, western Ethiopia. Anopheles stephensi was the predominant species in four of the eight positive sites, accounting for 75–100% relative abundance of the adult Anopheles catches. Household-level exposure, defined as the percentage of households with a peridomestic presence of An. stephensi, ranged from 18% in Metehara to 30% in Danan. Anopheles arabiensis was the predominant species in 20 of the 26 sites, accounting for 42.9–100% of the Anopheles catches. Bovine blood index, ovine blood index and human blood index values were 69.2%, 32.3% and 24.6%, respectively, for An. stephensi, and 65.4%, 46.7% and 35.8%, respectively, for An. arabiensis. None of the 197 An. stephensi mosquitoes assayed tested positive for Plasmodium sporozoite, while of the 1434 An. arabiensis mosquitoes assayed, 62 were positive for Plasmodium (10 for P. falciparum and 52 for P. vivax). Conclusions: This study shows that the geographical range of An. stephensi has expanded to western Ethiopia. Strongly zoophagic behavior coupled with low adult catches might explain the absence of Plasmodium infection. The level of household exposure to An. stephensi in this study varied across positive sites. Further research is needed to better understand the bionomics and contribution of An. stephensi to malaria transmission. Graphical Abstract

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress