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

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

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

Social psychiatry and psychiatric epidemiology functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study

Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing communityascertained cohort of people with SMD (n= 218), and attendees at the Butajira General Hospital psychiatric clinic (n= 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding two years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS), were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects and internalized stigma were associated with functional impairment across self reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted

Etoricoxib - preemptive and postoperative analgesia (EPPA) in patients with laparotomy or thoracotomy - design and protocols

<p>Abstract</p> <p>Background and Objective</p> <p>Our objective was to report on the design and essentials of the <it>Etoricoxib </it>protocol<it>- Preemptive and Postoperative Analgesia (EPPA) </it>Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy.</p> <p>Design and Methods</p> <p>The study is a 2 × 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 × 2 factorial study design). The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA). Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms.</p> <p>Discussion</p> <p>The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain.</p> <p>Trial registration</p> <p>NCT00716833</p

Local Increase of Arginase Activity in Lesions of Patients with Cutaneous Leishmaniasis in Ethiopia

The leishmaniases are a complex of diseases caused by Leishmania parasites. Currently, the diseases affect an estimated 12 million people in 88 countries, and approximately 350 million more people are at risk. The leishmaniases belong to the most neglected tropical diseases, affecting the poorest populations, for whom access to diagnosis and effective treatment are often not available. Leishmania parasites infect cells of the immune system called macrophages, which have the capacity to eliminate the intracellular parasites when they receive the appropriate signals from other cells of the immune system. In nonhealing persistent leishmaniasis, lymphocytes are unable to transmit the signals to macrophages required to kill the intracellular parasites. The local upregulation of the enzyme arginase has been shown to impair lymphocyte effector functions at the site of pathology. In this study, we tested the activity of this enzyme in skin lesions of patients presenting with localized cutaneous leishmaniasis. Our results show that arginase is highly upregulated in these lesions. This increase in arginase activity coincides with lower expression of a signalling molecule in lymphocytes, which is essential for efficient activation of these cells. These results suggest that increased arginase expression in the localized cutaneous lesions might contribute to persistent disease in patients presenting with cutaneous leishmaniasis

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold &gt;75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold &lt;0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold &lt;1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill &amp; Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations