Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia

Background: Delay in treatment is also likely to be associated with a greater number of secondary cases per index case. Objective: to assess the length of patient and health system delays; and identify factors influencing these delays among pulmonary tuberculosis patients. Methods: We conducted a cross-sectional study in 13 selected government health facilities that provide both diagnostic and treatment services using Directly Observed Treatment Short course (DOTS) program. Data were collected from pulmonary TB patients aged 15 years and above during their intensive phase of DOTS treatment using a semi-structured questionnaire. Results: The median total delay was 90 days; with 28 days patient delay and 42 days health system delay. A large proportion (63%) of the overall total delay was contributed by health system delay. Patients from urban areas were 46% more likely to present to health care providers than patients from rural areas, adjusted hazard ratio (AHR) of 1.46 (95% CI: 1.10 - 1.95). Patients from urban areas were 54% more likely to be diagnosed and start treatment earlier than patients from rural areas, AHR of 1.54 (95% CI: 1.15-2.07). Female patients were more delayed to present to health providers than their male counterparts with AHR of 0.63 (95%CI: 0.47–0.84) but had shorter health system delay than male patients with AHR of 1.51 (95% CI: 1.1-22.04). Conclusion: A greater proportion of the overall total delay was contributed by health system delay. The health system should be more accessible for the unmet need. New approaches to make health services more accessible to those in greatest need (rural and women) should be designed and developed.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 148-15

The effect of dams and seasons on malaria incidence and anopheles abundance in Ethiopia

Background: Reservoirs created by damming rivers are often believed to increase malaria incidence risk and/or stretch the period of malaria transmission. In this paper, we report the effects of a mega hydropower dam on P. falciparum malaria incidence in Ethiopia. Methods: A longitudinal cohort study was conducted over a period of 2 years to determine Plasmodium falciparum malaria incidence among children less than 10 years of age living near a mega hydropower dam in Ethiopia. A total of 2080 children from 16 villages located at different distances from a hydropower dam were followed up from 2008 to 2010 using active detection of cases based on weekly house to house visits. Of this cohort of children, 951 (48.09%) were females and 1059 (51.91%) were males, with a median age of 5 years. Malaria vectors were simultaneously surveyed in all the 16 study villages. Frailty models were used to explore associations between time-to-malaria and potential risk factors, whereas, mixed-effects Poisson regression models were used to assess the effect of different covariates on anopheline abundance. Results: Overall, 548 (26.86%) children experienced at least one clinical malaria episode during the follow up period with mean incidence rate of 14.26 cases/1000 child-months at risk (95% CI: 12.16 -16.36). P. falciparum malaria incidence showed no statistically significant association with distance from the dam reservoir (p = 0.32). However, P. falciparum incidence varied significantly between seasons (p < 0.01). The malaria vector, Anopheles arabiensis, was however more abundant in villages nearer to the dam reservoir. Conclusions: P. falciparum malaria incidence dynamics were more influenced by seasonal drivers than by the dam reservoir itself. The findings could have implications in timing optimal malaria control interventions and in developing an early warning system in Ethiopia

GENETIC DIVERSITY AND ECO-GEOGRAPHICAL DISTRIBUTION OF ELEUSINE SPECIES COLLECTED FROM ETHIOPIA

Eleusine is a small grass genus with three basic chromosome numbers (x=8, 9 and 10) and comprises of eight species including E. coracana subsp. coracana, (finger millet), which is an important subsistence crop in Africa and India. Research on these species could assist the development of high yielding and multiple stress tolerant variety(s) of the cultivable species, and also guide development of strategic genetic resource management and utilisation of the genus. A total of 72 accessions, sampled from five major species, E. coracana (including both E. coracana subsp. coracana and E. coracana subsp. africana), E. intermedia, E. indica, E. multiflora and E. floccifolia were analysed for genetic variation and inter-relationships using 20 microsatellite markers. All the SSR markers displayed high genetic polymorphism, with polymorphic information content ranging from 0.46 (UGEP110) to 0.91 (UGEP66). A total of 286 alleles were observed with an average of 14.3 alleles per locus. Classic F-statistics revealed the highest intra-specific polymorphism recorded for E. africana (32.45%), followed by E. coracana (16.83%); implying that genetic polymorphism is higher in the cultivable subspecies and its wild relatives, than the other species. Allelic frequency based inter-species genetic distance analysis, showed wider genetic distance between E. indica and E. multiflora (0.719); a narrow genetic distance between E. coracana sub-species africana and E. coracana subspecies coracana (0.3297). The weighted neighbor joining-based clustering revealed that the majority of the accessions in a species share strong similarity and are grouped together than do accessions of inter species.Eleusine est une herbe avec trois nombres de chromosomes de base (x=8, 9 et 10) et comprend huit esp\ue8ces dont E. coracana subsp. coracana, (finger millet), qui est une culture de subsistence importante en Afrique et en Inde. La recherche sur ces esp\ue8ces pourrait aider dans le d\ue9veloppement des vari\ue9t\ue9s d\u2019esp\ue8ces cultivables \ue0 rendement \ue9lev\ue9 et de tol\ue9rance aux stress multiples, et guider le d\ue9veloppement de la gestion des ressources g\ue9n\ue9tiques strat\ue9giques et l\u2019utilisation du genus. Un total de 72 accessions \ue9chantillonn\ue9es de cinq esp\ue8ces majeurs \ue0 savoir E. coracana (incluant E. coracana subsp. coracana et E. coracana subsp. africana), E. intermedia, E. indica, E. multiflora et E. floccifolia \ue9taient analys\ue9es pour variation g\ue9n\ue9tique et relations mutuelles utilisant 20 marqueurs microsatellites. Tous les marquers SSR ont manifest\ue9 un polymorphisme g\ue9n\ue9tique \ue9lev\ue9, avec un contenu d\u2019information polymorphique allant de 0.46 (UGEP110) \ue0 0.91 (UGEP66). Un total de 286 all\ue8les \ue9tait observ\ue9 avec une moyenne de 14.3 all\ue8les par locus. Les statistiqies classiques F ont r\ue9v\ue9l\ue9 le polymorphisme intrasp\ue9cifique le plus \ue9lev\ue9 enregistr\ue9 pour le E. africana (32.45%), suivi de E. coracana (16.83%), ce qui implique que le polymorphisme g\ue9n\ue9tique est le plus \ue9lev\ue9 dans les sous esp\ue8ces cultivables et ses homologues sauvages que les autres esp\ue8ces. L\u2019analyse de la fr\ue9quence all\ue9lique de la distance g\ue9n\ue9tique entre esp\ue8ces a montr\ue9 une plus large distance g\ue9n\ue9tique entre E. indica et E. multiflora (0.719); une \ue9troite distance g\ue9n\ue9tique entre les sous esp\ue8ces Africana de E. coracana et les sous esp\ue8ces coracana de E. coracana (0.3297). La pond\ue9ration des groupements a r\ue9v\ue9l\ue9 que la majorit\ue9 des accessions au sein d\u2019une esp\ue8ce partage une forte similarit\ue9 et sont group\ue9es ensemble en comparaison aux accessions des intra-esp\ue8ces

Integrated Modelling Frameworks for Environmental Assessment and Decision Support

As argued in Chapter 1, modern management of environmental resources defines problems from a holistic and integrated perspective, thereby imposing strong requirements on Environmental Decision Support Systems (EDSSs) and Integrated Assessment Tools (IATs). These systems and tools tend to be increasingly complex in terms of software architecture and computational power in order to cope with the type of problems they must solve. For instance, the discipline of Integrated Assessment (IA) needs tools that arc able to span a wide range of disciplines, from socio-economics to ecology to hydrology. Such tools must support a wide range of methodologies and techniques like agent-based modeling, Bayesian decision networks, optimization, multicriteria analyses and visualization tools, to name a few

Raltegravir Cerebrospinal Fluid Concentrations in HIV-1 Infection

Raltegravir is an HIV-1 integrase inhibitor currently used in treatment-experienced HIV-1-infected patients resistant to other drug classes. In order to assess its central nervous system penetration, we measured raltegravir concentrations in cerebrospinal fluid (CSF) and plasma in subjects receiving antiretroviral treatment regimens containing this drug.Raltegravir concentrations were determined by liquid chromatography tandem mass spectrometry in 25 paired CSF and plasma samples from 16 HIV-1-infected individuals. The lower limit of quantitation was 2.0 ng/ml for CSF and 10 ng/ml for plasma.Twenty-four of the 25 CSF samples had detectable raltegravir concentrations with a median raltegravir concentration of 18.4 ng/ml (range, <2.0-126.0). The median plasma raltegravir concentration was 448 ng/ml (range, 37-5180). CSF raltegravir concentrations correlated with CSF:plasma albumin ratios and CSF albumin concentrations.Approximately 50% of the CSF specimens exceeded the IC(95) levels reported to inhibit HIV-1 strains without resistance to integrase inhibitors. In addition to contributing to control of systemic HIV-1 infection, raltegravir achieves local inhibitory concentrations in CSF in most, but not all, patients. Blood-brain and blood-CSF barriers likely restrict drug entry, while enhanced permeability of these barriers enhances drug entry

Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

High APACHE II score and long length of bowel resection impair the outcomes in patients with necrotic bowel induced hepatic portal venous gas

<p>Abstract</p> <p>Background</p> <p>Hepatic portal venous gas (HPVG) is a rare but potentially lethal condition, especially when it results from intestinal ischemia. Since the literatures regarding the prognostic factors of HPVG are still scarce, we aimed to investigate the risk factor of perioperative mortality in this study.</p> <p>Methods</p> <p>We analyzed data for patients with intestinal ischemia induced HPVG by chart review in our hospital between 2000 and 2007. Factors associated with perioperative mortality were specifically analyzed.</p> <p>Results</p> <p>There were 22 consecutive patients receiving definite bowel resection. 13 cases (59.1%) died after surgical intervention. When analyzing the mortality in patients after bowel resections, high Acute Physiology And Chronic health Evaluation (APACHE) II score (<it>p < 0.01</it>) and longer length of bowel resection (<it>p </it>= 0.047) were significantly associated with mortality in univariate analyses. The complication rate was 66.7% in alive patients after definite bowel resection.</p> <p>Conclusions</p> <p>Bowel resection was the only potential life-saving therapy for patients with mesenteric ischemia induced HPVG. High APACHE II score and severity of underlying necrotic bowel determined the results in patients after bowel resection.</p

Jejunal Diverticular Perforation due to Enterolith

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded