Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study

<p>Abstract</p> <p>Background</p> <p>The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend.</p> <p>Objectives</p> <p>The overall aim of this study was to analyze trends of and develop model for prediction of Health and Health related indicators. More specifically, it described the trends of Health and Health related indicators, identified determinants of mortality and morbidity indicators and developed model for predicting future values of MDG indicators.</p> <p>Methods</p> <p>This study was conducted on Health and Health related indicators of Ethiopia from the year 1987 E.C to 2000 E.C. Key indicators of Mortality and Morbidity, Health service coverage, Health systems resources, Demographic and socio-economic, and Risk factor indicators were extracted and analyzed. The trends in these indicators were established using trend analysis techniques. The determinants of the established trends were identified using ARIMA models in STATA. The trend-line equations were then used to predict future values of the indicators.</p> <p>Results</p> <p>Among the mortality indicators considered in this study, it was only Maternal Mortality Ratio that showed statistically significant decrement within the study period. The trends of Total Fertility Rate, physician per 100,000 population, skilled birth attendance and postnatal care coverage were found to have significant association with Maternal Mortality Ratio trend. There was a reversal of malaria parasite prevalence in 1999 E.C from <it>Plasmodium Falciparum </it>to <it>Plasmodium Vivax</it>. Based on the prediction from the current trend, the Millennium Development Goal target for under-five mortality rate and proportion of people having access to basic sanitation can be achieved.</p> <p>Conclusion</p> <p>The current trend indicates the need to accelerate the progress of the indicators to achieve MDGs at or before 2015, particularly for Maternal Health and access to safe water supply.</p

Cost-effectiveness analysis of clinical specialist outreach as compared to referral system in Ethiopia: an economic evaluation

BACKGROUND: In countries with scarce specialized Human resource for health, patients are usually referred. The other alternative has been mobilizing specialists, clinical specialist outreach. This study examines whether clinical specialist outreach is a cost effective way of using scarce health expertise to provide specialist care as compared to provision of such services through referral system in Ethiopia. METHODS: A cross-sectional study on four purposively selected regional hospitals and three central referral hospitals was conducted from Feb 4-24, 2009. The perspective of analysis was societal covering analytic horizon and time frame from 1 April 2007 to 31 Dec 2008. Data were collected using interview of specialists, project focal persons, patients and review of records. To ensure the propriety standards of evaluation, Ethical clearance was obtained from Jimma University. RESULTS: It was found that 532 patients were operated at outreach hospitals in 125 specialist days. The unit cost of surgical procedures was found to be ETB 4,499.43. On the other hand, if the 125 clinical specialist days were spent to serve patients referred from zonal and regional hospitals at central referral hospitals, 438 patients could have been served. And the unit cost of surgical procedures through referral would have been ETB 6,523.27 per patient. This makes clinical specialist outreach 1.45 times more cost effective way of using scarce clinical specialists' time as compared to referral system. CONCLUSION: Clinical specialist outreach is a cost effective and cost saving way of spending clinical specialists' time as compared to provision of similar services through referral system

Feed resources availability, utilization and marketing in central and eastern Tigray, northern Ethiopia

This survey explored the situation of different feed resources for ruminant livestock in two zones (central and eastern) in Tigray region of northern Ethiopia. These two zones account for the region’s 12% of the total land mass, 23% of the human population, 28% of the cattle population, and 56% of the small ruminant population. Farmers feed their livestock a variety of feed resources that range from crop residues to non-conventional feeds.The overall contribution of crop residues exceeds 50% of the livestock feeds currently used by smallholder farmers, and this reflects the level of integration between crop and livestock farming. Overall, the management and utilization of crop residues with particular attention to collection and transportation is constrained by factors such as labour shortage, distance from harvesting field to animals and delayed harvest in the project districts. Grazing land management and improvement is seldom considered by farmers or the extension system. Acute shortages of AIBPs supply from the sources and high price fluctuation in the main towns of the districts are discouraging smallholder dairy and small ruminant farmers from using them on a regular basis. The contribution of improved forage plants is not as expected and forage genetic material multiplication sites are operating with insufficient budget and manpower, and not supported by proper research. The overall feed supply to demand ratio in four districts in the eastern zone is not enough to cover the annual maintenance requirements of the present stock

A Quantum Theory of Cold Bosonic Atoms in Optical Lattices

Ultracold atoms in optical lattices undergo a quantum phase transition from a superfluid to a Mott insulator as the lattice potential depth is increased. We describe an approximate theory of interacting bosons in optical lattices which provides a qualitative description of both superfluid and insulator states. The theory is based on a change of variables in which the boson coherent state amplitude is replaced by an effective potential which promotes phase coherence between different number states on each lattice site. It is illustrated here by applying it to uniform and fully frustrated lattice cases, but is simple enough that it can easily be applied to spatially inhomogeneous lattice systems

Thyroid Hormone Tests Ordering Practice and Cost-Effectiveness in Samples Referred to International Clinical Laboratories from Addis Ababa Health Facilities

BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves’ disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients’ samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL.RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal.CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common

Diagnosis and treatment of microsporidial keratoconjunctivitis: literature review and case series

PURPOSE: The purpose of this study is to describe the clinical characteristics, microscopic findings, and treatment response to albendazole of microsporidial keratoconjunctivitis among immunocompromised individuals with HIV/AIDS. METHODS: This is a retrospective case series. Diagnosis of microsporidial keratoconjunctivitis was confirmed by subspecialist examination and conjunctival swabs examined by light microscopy. HIV infection was documented, and absolute CD4+ T cell count was determined. Patients were treated with albendazole and followed for clinical response. RESULTS: Light microscopy from the conjunctival swabs demonstrated myriad small, round to oval microsporidial organisms that stained positively with modified acid-fast methods. Two of the patients initially not taking highly active antiretroviral therapy (HAART) and presenting with an absolute CD4+ T cell count less than 100 cells/μL had a more severe form of keratoconjunctivitis than the third patient (receiving HAART, with a CD4+ T cell count of 259 cells/μL). All patients were started or continued on HAART. Two of the patients responded to oral albendazole, with resolution of symptoms and signs. The third patient did not initially respond, perhaps because of an immune recovery inflammatory syndrome, but subsequently had temporary improvement with albendazole. CONCLUSIONS: Microsporidial keratoconjunctivitis is a rare ocular complication of HIV/AIDS. Light microscopic evaluation of conjunctival swabs may be a useful minimally invasive first step toward diagnosis of microsporidial keratoconjunctivis in settings where electron microscopy is not available. Based on the limited available information, albendazole often is effective for this condition, and is widely available in developing countries at low cost

Chimeric Anti-Staphylococcal Enterotoxin B Antibodies and Lovastatin Act Synergistically to Provide In Vivo Protection against Lethal Doses of SEB

Staphylococcal enterotoxin B (SEB) is one of a family of toxins secreted by Staphylococcus aureus that act as superantigens, activating a large fraction of the T-cell population and inducing production of high levels of inflammatory cytokines that can cause toxic shock syndrome (TSS) and death. Extracellular engagement of the TCR of T-cells and class II MHC of antigen presenting cells by SEB triggers the activation of many intracellular signaling processes. We engineered chimeric antibodies to block the extracellular engagement of cellular receptors by SEB and used a statin to inhibit intracellular signaling. Chimeric human-mouse antibodies directed against different neutralizing epitopes of SEB synergistically inhibited its activation of human T-cells in vitro. In the in vivo model of lethal toxic shock syndrome (TSS) in HLA-DR3 transgenic mice, two of these antibodies conferred significant partial protection when administered individually, but offered complete protection in a synergistic manner when given together. Similarly, in vivo, lovastatin alone conferred only partial protection from TSS similar to single anti-SEB antibodies. However, used in combination with one chimeric neutralizing anti-SEB antibody, lovastatin provided complete protection against lethal TSS in HLA-DR3 transgenic mice. These experiments demonstrate that in vivo protection against lethal doses of SEB can be achieved by a statin of proven clinical safety and chimeric human-mouse antibodies, agents now widely used and known to be of low immunogenicity in human hosts