Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Introduction: While the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them. Methods: In this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630). Results: According to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers. Conclusion: Our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components

Patterns of MRI Findings in Patients with Chronic Headache: A Retrospective Study from a Private Diagnostic Center in Addis Ababa, Ethiopia

BACKGROUND: Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. MATERIALS AND METHODS: This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. RESULTS: Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 + 0.5 years and a median of 37 + 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. CONCLUSION: It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01).  There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations

Microbiological Safety of Street Vended Foods in Jigjiga City, Eastern Ethiopia

Background: Food safety problems are particularly becoming an increasingly serious threat to public health in developing countries. This study was conducted to assess microbiological safety of street vended foods from May to November, 2014 in Jigjiga City.Methods: A cross-sectional design was used to answer questions concerning the current status of food hygiene and sanitation practire of street food vending sites. Interview and observational assessments were used to collect socio-demographic data about street food venders. One hundred thirty-two samples of street foods were aseptically collected from four ‘kebeles’ of Jigjiga City. Both descriptive and analytical statistical methods were applied.Results: The majority of the street food vendors were women, 120(90.9%), with the average age group of 23-49 years, (42.85%), and 99(66.7%) them were illiterate. The study revealed that 95(72%) of the food samples had pathogenic bacterial contaminations. Three different bacterial species were isolated: E. coli 68(51.5%), S. aureus 85(64.4%) and 26(19.7%) Salmonella species. The highest incidence of S. aureus 23/33(69%) was seen in ‘Sambusa’; the highest incidence of E. coli 24/33(73.5%) was observed in ‘Pasta’, while the highest Salmonella incidence was observed in ‘Ades’.Conclusion: This study revealed that there is a reasonable gap on food safety knowledge among street food venders. The microbial profile was also higher compared to standards set by the World Health Organization. Due attention should be given by the government to improve knowledge about food safety and the quality standard of street foods sold in the City.Keywords: Microbiological safety, Street vended foods, Isolation, Jigjig

Quality of fixed dose artemether/lumefantrine products in Jimma Zone, Ethiopia

Background: Malaria caused by Plasmodium vivax and Plasmodium falciparum is among the major public health problems in most endemic areas of the world. Artemisinin-based combination therapy (ACT) has been recommended as a first-line treatment for uncomplicated Plasmodium falciparum malaria almost in all endemic regions. Since ineffectively regulated medicines in resource limited settings could favour infiltration of poor quality anti-malarial medicines into pharmaceutical supply chain and jeopardize a positive treatment outcome, regular monitoring of the quality of anti-malarial medicines is critical. Thus, the aim of this study was to assess the quality of fixed dose combination (FDC) artemether (ART)/lumefantrine (LUM) tablets available in Jimma zone, Ethiopia. Methods: This study was conducted in Jimma zone, Ethiopia. A total of 74 samples of FDC ART/LUM (20mg ART/120mg LUM) tablets were collected from 27 public facilities. All samples were subjected to visual inspection and the relevant information was recorded. The samples were transported to Jimma University Laboratory of Drug Quality (JuLaDQ) and stored at ambient temperature (20 degrees C to 25 degrees C) until analysis. The Pharmacopoeial conform/non-conform methods and the risk-based Derringer's desirability function approach were employed to assess the pharmaceutical quality of the investigated products. Results: The visual inspection results revealed that there were no signs of falsified in the investigated products. Identification test results of samples indicated that all samples contained the stated active pharmaceutical ingredients (APIs). The results of uniformity of mass indicated that all samples complied with International Pharmacopoeial specification limits. The assay results, expressed as percent label claim (%lc) of ART (89.8 to 108.8%, meanSD=99.1 +/- 3.9%) and LUM (90.0 to 111.9%, mean +/- SD=98.2 +/- 3.8%) revealed that, all samples complied with International Pharmacopoeia acceptance specification limits (i.e. 90-110%lc), except one generic product (IPCA Laboratories Ltd., India) which contains excessive LUM (111.9 +/- 1.7%lc). The risk priority number (RPN) results revealed that assay (RPN=392) is relatively the most critical quality attribute followed by identity (RPN=280) and mass uniformity (40). Quality evaluation based on psycho-physical Harrington's scale revealed that more than 96% of samples were within the acceptable ranges (D >= 0.7-1.0). Conclusions: Both Pharmacopoeial and risk-based desirability function approaches to quality evaluation applied to the investigated products revealed that above 96% FDC ART/LUM tablets circulating in public settings of Jimma zone are of good quality

Assessment of efficacy and quality of two albendazole brands commonly used against soil-transmitted helminth infections in school children in Jimma Town, Ethiopia

Background : There is a worldwide upscale in mass drug administration (MDA) programs to control the morbidity caused by soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura and hookworm. Although anthelminthic drugs which are used for MDA are supplied by two pharmaceutical companies through donation, there is a wide range of brands available on local markets for which the efficacy against STHs and quality remain poorly explored. In the present study, we evaluated the drug efficacy and quality of two albendazole brands (Bendex and Ovis) available on the local market in Ethiopia. Methodology/Principal Findings : A randomized clinical trial was conducted according to the World Health Organization (WHO) guidelines to assess drug efficacy, by means of egg reduction rate (ERR), of Bendex and Ovis against STH infections in school children in Jimma, Ethiopia. In addition, the chemical and physicochemical quality of the drugs was assessed according to the United States and European Pharmacopoeia, encompassing mass uniformity of the tablets, amount of active compound and dissolution profile. Both drugs were highly efficacious against A. lumbricoides (>97%), but showed poor efficacy against T. trichiura (similar to 20%). For hookworms, Ovis was significantly (p < 0.05) more efficacious compared to Bendex (98.1% vs. 88.7%). Assessment of the physicochemical quality of the drugs revealed a significant difference in dissolution profile, with Bendex having a slower dissolution than Ovis. Conclusion/Significance : The study revealed that differences in efficacy between the two brands of albendazole (ABZ) tablets against hookworm are linked to the differences in the in-vitro drug release profile. Differences in uptake and metabolism of this benzimidazole drug among different helminth species may explain that this efficacy difference was only observed in hookworms and not in the two other species. The results of the present study underscore the importance of assessing the chemical and physicochemical quality of drugs before conducting efficacy assessment in any clinical trials to ensure appropriate therapeutic efficacy and to exclude poor drug quality as a factor of reduced drug efficacy other than anthelminthic resistance. Overall, this paper demonstrates that "all medicines are not created equal"

Earning pocket money and girls' menstrual hygiene management in Ethiopia : a systematic review and meta-analysis

Background: Many adolescent girls in Ethiopia and elsewhere missed school during their monthly cycles due to a lack of affordable menstrual absorbent materials or money to buy sanitary pads. So far, few studies have looked into the relationship between earning pocket money and maintaining good menstrual hygiene. Hence, this systematic review and meta-analysis aimed to synthesize the best available evidence regarding the association between earning pocket money and menstrual hygiene management among adolescents in Ethiopia. Methods: We systematically searched PubMed, Hinari, Science Direct, Cochrane Library, ProQuest, POPLINE, African Journal Online, Direct of Open Access Journals, and Google Scholar for studies examining the association between earning pocket money and menstrual hygiene management among adolescent girls in Ethiopia, without restriction in a publication year. The Joanna Briggs Institute quality assessment tool for the cross-sectional studies was used to assess the quality of included studies. A prefabricated checklist, including variables: first author, publication year, sample size, type of questionnaire, and the region was used to extract data from the selected articles. A random-effect meta-analysis model was used to estimate the pooled odds ratio (OR) of the association between earning pocket money and menstrual hygiene management. The heterogeneity and publication bias was assessed by using I2 test statistics and Egger’s test, respectively. Results: Data from nine studies involving 4783 adolescent girls were extracted. The meta-analysis revealed that adolescent girls who earned pocket money from their parents or relative had 1.64 times higher odds of having good menstrual hygiene management than their counterparts [pooled OR = 1.64, 95% CI: 1.16–2.34, I2:66.7%, n = 7 (number of studies)]. Similarly, the likelihood of having good menstrual hygiene management was lower by 49% among adolescent girls who did not receive any pocket money from their parents compared to their counterparts (pooled OR = 0.51, 95% CI: 0.35–0.74, I2:48.4%, n = 2). Conclusions: The findings revealed that adolescent girls who earned pocket money were more likely to practice good menstrual hygiene management. Progress toward better menstrual hygiene will necessitate consideration of this factor

Spatial distribution of Glossina sp. and Trypanosoma sp. in south-western Ethiopia

Background Accurate information on the distribution of the tsetse fly is of paramount importance to better control animal trypanosomosis. Entomological and parasitological surveys were conducted in the tsetse belt of south-western Ethiopia to describe the prevalence of trypanosomosis (PoT), the abundance of tsetse flies (AT) and to evaluate the association with potential risk factors. Methods The study was conducted between 2009 and 2012. The parasitological survey data were analysed by a random effects logistic regression model, whereas the entomological survey data were analysed by a Poisson regression model. The percentage of animals with trypanosomosis was regressed on the tsetse fly count using a random effects logistic regression model. Results The following six risk factors were evaluated for PoT (i) altitude: significant and inverse correlation with trypanosomosis, (ii) annual variation of PoT: no significant difference between years, (iii) regional state: compared to Benishangul-Gumuz (18.0 %), the three remaining regional states showed significantly lower PoT, (iv) river system: the PoT differed significantly between the river systems, (iv) sex: male animals (11.0 %) were more affected than females (9.0 %), and finally (vi) age at sampling: no difference between the considered classes. Observed trypanosome species were T. congolense (76.0 %), T. vivax (18.1 %), T. b. brucei (3.6 %), and mixed T. congolense/vivax (2.4 %). The first four risk factors listed above were also evaluated for AT, and all have a significant effect on AT. In the multivariable model only altitude was retained with AT decreasing with increasing altitude. Four different Glossina species were identified i.e. G. tachinoides (52.0 %), G. pallidipes (26.0 %), G.morsitans submorsitans (15.0 %) and G. fuscipes fuscipes (7.0 %). Significant differences in catches/trap/day between districts were observed for each species. No association could be found between the tsetse fly counts and trypanosomosis prevalence. Conclusions Trypanosomosis remains a constraint to livestock production in south-western Ethiopia. Four Glossina and three Trypanosoma species were observed. Altitude had a significant impact on AT and PoT. PoT is not associated with AT, which could be explained by the importance of mechanical transmission. This needs to be investigated further as it might jeopardize control strategies that target the tsetse fly population

Insecticide resistance in Anopheles arabiensis from Ethiopia (2012-2016): a nationwide study for insecticide resistance monitoring.

BACKGROUND: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) remain the cornerstones of malaria vector control. However, the development of insecticide resistance and its implications for operational failure of preventative strategies are of concern. The aim of this study was to characterize insecticide resistance among Anopheles arabiensis populations in Ethiopia and describe temporal and spatial patterns of resistance between 2012 and 2016. METHODS: Between 2012 and 2016, resistance status of An. arabiensis was assessed annually during the long rainy seasons in study sites from seven of the nine regions in Ethiopia. Insecticide resistance levels were measured with WHO susceptibility tests and CDC bottle bioassays using insecticides from four chemical classes (organochlorines, pyrethroids, organophosphates and carbamates), with minor variations in insecticides tested and assays conducted between years. In selected sites, CDC synergist assays were performed by pre-exposing mosquitoes to piperonyl butoxide (PBO). In 2015 and 2016, mosquitoes from DDT and deltamethrin bioassays were randomly selected, identified to species-level and screened for knockdown resistance (kdr) by PCR. RESULTS: Intense resistance to DDT and pyrethroids was pervasive across Ethiopia, consistent with historic use of DDT for IRS and concomitant increases in insecticide-treated net coverage over the last 15 years. Longitudinal resistance trends to malathion, bendiocarb, propoxur and pirimiphos-methyl corresponded to shifts in the national insecticide policy. By 2016, resistance to the latter two insecticides had emerged, with the potential to jeopardize future long-term effectiveness of vector control activities in these areas. Between 2015 and 2016, the West African (L1014F) kdr allele was detected in 74.1% (n = 686/926) of specimens, with frequencies ranging from 31 to 100% and 33 to 100% in survivors from DDT and deltamethrin bioassays, respectively. Restoration of mosquito susceptibility, following pre-exposure to PBO, along with a lack of association between kdr allele frequency and An. arabiensis mortality rate, both indicate metabolic and target-site mutation mechanisms are contributing to insecticide resistance. CONCLUSIONS: Data generated by this study will strengthen the National Malaria Control Programme's insecticide resistance management strategy to safeguard continued efficacy of IRS and other malaria control methods in Ethiopia