Cold chain status at immunisation centres in Ethiopia

Background: Child immunisation is among the most cost-effective ways of preventing premature child deaths, and the potency of vaccines, crucial for vaccine efficacy, is dependent on effective management of the cold chain at all levels of vaccine handling.Objective: To assess the status of the cold chain at peripheral vaccine stores in Ethiopia.Design: Institution based cross-sectional survey in two rural and one urban administrative areas were included in the study. Sixty seven health institutions providing static vaccination services were included in the study but cold chain system was assessed fully in only sixty four.Data were collected by interviewing health workers and by directly observing the cold chain equipment and records using structured forms.Results: Conditions of the cold chain system were described based on 64 of the 67 centres visited, three were excluded because of non-functioning cold chain. Complete temperature record was observed in 37(57.8%) of the centres. Thermometer was not available in four(6.3%) and thermometer reading was found to be outside the optimal range in another seven (10.9%) centres. Vaccine storage in the refrigerator was not proper in 47 (73.4%) centres. Majority of the centres had neither trained personnel nor budget for maintenance of the cold chain.Conclusion: There is a real danger of vaccines losing their potency at these centres even if they were potent on arrival. Relevant training for those handling the cold chain, improving the maintenance conditions of refrigerators and introduction of cold chain monitoring devises are recommended

Prevalence of Disability and Associated Factors among Registered Leprosy Patients in All Africa Tb and Leprosy Rehabilitation and Training Centre (ALERT), Addis Ababa, Ethiopia

BACKGROUND: Delay in leprosy diagnosis and treatment causes disabilities due to nerve damage, immunological reactions and bacillary infiltration. Leprosy disability leads not only to physical dysfunction and activity limitation but also disrupts social interaction of affected individuals by creating stigma and discrimination. This study was aimed at assessing leprosy disability status in patients registered at All African TB and Leprosy Rehabilitation and Training Centre.METHODS: Medical records of leprosy patients registered from September 11, 2010 to September 10, 2013 G.C were reviewed. Prevalence of disability calculated, bivariate and multiple logistic regressions were used to determine crude and adjusted odds ratios with 95% confidence interval.RESULTS: The overall prevalence of disability was found to be 65.9% from all categories of patients (40.2% Grade I and 25.7% Grade II). The Prevalence among the new category was 62.8% (39.1% Grade 1 and 23.7% Grade 2). Those ageed above 30 years, with duration of symptoms 6-12 months and above 24 months, with sensory loss, nerve damage and reversal reaction were more likely to develop disability.CONCLUSION: In this study the prevalence of disability, both Grade I and II, is very high. Disability was associated with age, duration of symptom, sensory loss, signs of nerve damage and reversal reaction. These risk factors indicate the existence of delay in diagnosis and treatment of leprosy cases. Therefore, the national leprosy control program should investigate leprosy case detection and diagnosis system in the country and work on improving early case detection and prevention of disability.KEYWORDS: Leprosy, leprosy disability, Ethiopi

Diversion of the melanin synthetic pathway by dopamine product scavengers: A quantum chemical modeling of the reaction mechanisms

We report the stability and reactivity of the oxidation products as well as L-cysteine and N-acetylcysteine adducts of dopamine studied using quantum chemical calculations. The overall reactions studied were subdivided into four reaction channels. The first reaction channel is the oxidation of dopamine to form dopaminoquinone. The second reaction channel leads to melanin formation through subsequent reactions. The third and fourth reaction channels are reactions leading to the formation of dopaminoquinone adducts which are aimed to divert the synthesis of melanin. The results indicate that L-cysteine and N-acetylcysteine undergo chemical reactions mainly at C5 position of dopaminoquinone. The analyses of the thermodynamic energies indicate that L-cysteine and N-acetylcysteine covalently bind to dopaminoquinone by competing with the internal cyclization reaction of dopaminoquinone which leads to the synthesis of melanin. The analysis of the results, based on the reaction free energies, is also supported by the investigation of the natural bond orbitals of the reactants and products. KEY WORDS: Dopamine, Melanin, L-Cysteine, N-Acetylcysteine, DFT calculations Bull. Chem. Soc. Ethiop. 2016, 30(3), 437-448DOI: http://dx.doi.org/10.4314/bcse.v30i3.1

Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates Among Burn Patients at Yekatit 12 Hospital Burn Center, Addis Ababa, Ethiopia

Background: Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.Methods: A cross sectional study was conducted at Yekatit 12 Hospital Burn Center. Blood specimen and wound swab were collected from burn patients and were cultured by conventional method. Sensitivity/susceptibility pattern of the isolates was determined by disc diffusion method. Some of the risk factors of bacteremia like prior antibiotic use and total body surface area burn were also determined.Results: Fifty patients were enrolled in the study of whom 21(42%) were found bacteremic. Five different bacteria were isolated from blood specimen. Coagulase negative Staphylococci, 9(42.8%), S. aureus, 8(38.2%), Bacillus spps, 2(9.52%), K. pneumoniae, 1(4.8%), and P. aeruginosa, 1(4.8%), were frequent isolates. From wound swab, S. aureus, (34.04%), and P. aeruginosa, (31.8%), were predominant. Antimicrobial resistance was observed for Ampicillin, (77.4%), Doxycycline, (74.0), Nalidixic acid, (70.5%), Penicillin G, (68.2%), and tetracycline, (67.5%). Total body surface area of burn ≥ 15% was found as a risk factor for bacteremia.Conclusion: Bacteremia was detected at a rate of 42% among burn patients. Frequent isolates were S. aureus, (34.04%), and P. aeruginosa, (31.8%). About 82.16% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.Keywords: Bacteraemia, Burn, Sepsis, Thermal injur

Prevalence of group B Streptococcus colonization among pregnant women attending antenatal clinic of Hawassa Health Center, Hawassa, Ethiopia

Background: Group B streptococcus (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. GBS has become the major cause of bacterial infections in the peri-natal period, includingbacteraemia, amnionitis, endometritis, and urinary tract infection in pregnant women as well as sepsis and meningitis in neonates and young infants. Infection of the new born may be acquired by the intra-amniotic route or directly during passage through the birth canal.Objectives: This study was undertaken to determine the prevalence of group B Streptococcus (GBS) colonization and to analyze related risk factors among pregnant women attending the antenatal clinic of Hawassa Health centre, Adare Hospital Hawassa, Ethiopia.Methods: A total of 139 pregnant women were screened for GBS  colonization between May and June 2010. Standard microbiological methods were used to isolate and identify GBS from vaginal and ano-rectal swabs obtained from study subjects. An antimicrobial susceptibility test was performed for all GBS isolates according to the criteria of the Clinical and laboratory Standards Institute (CLSI) by disk diffusion method.Results: A total of 29 out of 139 (20.9%) pregnant women were colonized by GBS. No statistically significant association was observed for GBS colonization with any of socio-demographic characteristics of the study subjects including age, occupation, type of contraceptive used, parity, number of antenatal clinic visits. All GBS strains were susceptible to penicillin, ampicillin, vancomycin and gentamicin. Resistance was observed against erythromycin (6.9%), tetracycline (48.2%), ceftriaxone (10.3%), chloramphenicol (51.7%), ciprofloxacin (13.8%) and norfloxacin(10.3%).Conclusion: This study showed that prevalence of GBS colonization was 20.9% among the study subjects. The finding of this study was comparable with findings reported from developed and developing countries. However,further epidemiological investigations should be done in different parts of the country in order to know the actual GBS colonization rate in pregnant women and to consider the use of intra-partum antibiotics prophylaxis for prevention of early onset GBS-neonatal diseases.[Ethiop. J. Health Dev. 2012;26(1):36-42

Journeys to tuberculosis treatment: a qualitative study of patients, families and communities in Jogjakarta, Indonesia

<p>Abstract</p> <p>Background</p> <p>Many tuberculosis (TB) patients in Indonesia are diagnosed late. We seek to document patient journeys toward TB diagnosis and treatment and factors that influence health care seeking behavior.</p> <p>Methods</p> <p>TB patients in Jogjakarta municipality (urban) and Kulon Progo district (rural) were recruited from health care facilities participating in the DOTS strategy and health care facilities not participating in the DOTS strategy, using purposive sampling methods. Data were collected through in-depth interviews with TB patients and members of their family and through Focus Group Discussions (FGD) with community members.</p> <p>Results</p> <p>In total, 67 TB patients and 22 family members were interviewed and 6 FGDs were performed. According to their care seeking behavior patients were categorized into National TB program's (NTP) dream cases (18%), 'slow-but-sure patients' (34%), 'shopaholics' (45%), and the NTP's nightmare case (3%). Care seeking behavior patterns did not seem to be influenced by gender, place of residence and educational level. Factors that influenced care seeking behavior include income and advice from household members or friends. Family members based their recommendation on previous experience and affordability. FGD results suggest that the majority of people in the urban area preferred the hospital or chest clinic for diagnosis and treatment of TB whereas in the rural area private practitioners were preferred. Knowledge about TB treatment being free of charge was better in the urban area. Many community members from the rural area doubted whether TB treatment would be available free of charge.</p> <p>Conclusion</p> <p>Most TB patients took over a month to reach a DOTS facility after symptoms appeared and had consulted a number of providers. Their income and advice from household members and friends were factors that influenced their care seeking behavior most.</p

Two-Thirds of Smear-Positive Tuberculosis Cases in the Community Were Undiagnosed in Northwest Ethiopia: Population Based Cross-Sectional Study

Background: Tuberculosis (TB) case detection rate remains low in Ethiopia. One of the underlying reasons is the emphasis on passive case finding strategy which may seriously underestimate the burden of the disease. Estimating the prevalence of smear-positive pulmonary TB through active case finding at population level can help assessing the degree to which passive case detection is successful. Methods and findings: This is population based cross-sectional study. The study population was all individuals aged $14 years. Interviews using a uniform questionnaire were done initially to identify individuals with chronic cough ($15 days) and the two sputum (spot and morning) samples were gathered for standard smear microscopy. A total of 23,590 individuals aged $14 years were interviewed and 984 had a chronic cough for$15 days. Of 831 individuals who provided two sputum samples for acid fast bacilli (AFB), 41 had positive smears. A total of 22 smear-positive TB cases detected through passive case finding were on anti-TB treatment. The prevalence of new smear-positive TB was 174 per 100,000 in persons aged $14 years (95$45 years [AOR: 2.26, 95 % CI (1.12–4.59). Conclusions: The study revealed that about two-thirds of patients with active TB remain undiagnosed and thus untreated. This may indicate the need for strengthening case detection at the community level. Furthermore, the high burden of T

Forest Drought Response Index (ForDRI): A New Combined Model to Monitor Forest Drought in the Eastern United States

Monitoring drought impacts in forest ecosystems is a complex process because forest ecosystems are composed of different species with heterogeneous structural compositions. Even though forest drought status is a key control on the carbon cycle, very few indices exist to monitor and predict forest drought stress. The Forest Drought Indicator (ForDRI) is a new monitoring tool developed by the National Drought Mitigation Center (NDMC) to identify forest drought stress. ForDRI integrates 12 types of data, including satellite, climate, evaporative demand, ground water, and soil moisture, into a single hybrid index to estimate tree stress. The model uses Principal Component Analysis (PCA) to determine the contribution of each input variable based on its covariance in the historical records (2003–2017). A 15-year time series of 780 ForDRI maps at a weekly interval were produced. The ForDRI values at a 12.5km spatial resolution were compared with normalized weekly Bowen ratio data, a biophysically based indicator of stress, from nine AmeriFlux sites. There were strong and significant correlations between Bowen ratio data and ForDRI at sites that had experienced intense drought. In addition, tree ring annual increment data at eight sites in four eastern U.S. national parks were compared with ForDRI values at the corresponding sites. The correlation between ForDRI and tree ring increments at the selected eight sites during the summer season ranged between 0.46 and 0.75. Generally, the correlation between the ForDRI and normalized Bowen ratio or tree ring increment are reasonably good and indicate the usefulness of the ForDRI model for estimating drought stress and providing decision support on forest drought management

Immune-Complex Mimics as a Molecular Platform for Adjuvant-Free Vaccine Delivery

Protein-based vaccine development faces the difficult challenge of finding robust yet non-toxic adjuvants suitable for humans. Here, using a molecular engineering approach, we have developed a molecular platform for generating self-adjuvanting immunogens that do not depend on exogenous adjuvants for induction of immune responses. These are based on the concept of Immune Complex Mimics (ICM), structures that are formed between an oligomeric antigen and a monoclonal antibody (mAb) to that antigen. In this way, the roles of antigens and antibodies within the structure of immune complexes are reversed, so that a single monoclonal antibody, rather than polyclonal sera or expensive mAb cocktails can be used. We tested this approach in the context of Mycobacterium tuberculosis (MTB) infection by linking the highly immunogenic and potentially protective Ag85B with the oligomeric Acr (alpha crystallin, HspX) antigen. When combined with an anti-Acr monoclonal antibody, the fusion protein formed ICM which bound to C1q component of the complement system and were readily taken up by antigen-presenting cells in vitro. ICM induced a strong Th1/Th2 mixed type antibody response, which was comparable to cholera toxin adjuvanted antigen, but only moderate levels of T cell proliferation and IFN-γ secretion. Unfortunately, the systemic administration of ICM did not confer statistically significant protection against intranasal MTB challenge, although a small BCG-boosting effect was observed. We conclude that ICM are capable of inducing strong humoral responses to incorporated antigens and may be a suitable vaccination approach for pathogens other than MTB, where antibody-based immunity may play a more protective role

Countdown to 2015: Ethiopia's progress towards reduction in under-five mortality: 2014 country case study

On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for accelerating health improvements and reducing child deaths