The potential of performance targets (imihigo) as drivers of energy planning and extending access to off‐grid energy in rural Rwanda

Rwanda has one of the lowest electrification rates in Sub‐Saharan Africa and ambitious targets of boosting energy access, with an encouraged private sector involvement. However, barriers such as end‐user awareness and participation in policy and business model design prohibit the pace of rural electrification. A case of Rwanda is analyzed, pointing to the potential of the imihigo (performance contracts) framework. Given the adoption of household‐level performance contracts, which can include energy access, it is proposed they could drive local participation among off‐grid communities. Results of a survey with 218 users of Solar Home Systems in North‐Western Rwanda and from five focus groups show that village‐level energy targets impact on the prioritization of energy target setting among households. Including off‐grid energy options in the imihigo booklets distributed to households could influence awareness raising and allow private sector providers to act in a more targeted way, prioritizing areas with most prevalent energy targets. Additionally, community meetings (umuganda) tied to imihigo offer participatory spaces for information and feedback sharing. These will assist in the design of energy planning and business models, which best fit local needs and respond to the challenges faced by the energy poor

Health facility-based maternal death audit in Tigray, Ethiopia

Background: Maternal deaths are often unrecognized and improperly documented in the health system. Objective: To identify causes of maternal death occurring in hospitals and determine avoidability of maternal death. Methods: The study assessed each death for the cause and surrounding circumstances as well as avoidable factors, by reviewing two years patient and facility records and interviewing individuals who were involved in caring for the deceased. Data were collected between December 2005 and May 2006. Result: A total of 34 maternal deaths were identified in five public hospitals in Tigray over a period of two years, of which 12 (35.2%) were reported to have been avoidable. The leading causes of death were infection, haemorrhage and hypertensive disorders. Avoidable factors were mainly related to hospital service or medical factors such as lack of blood for transfusion, delay in transfusion, and inappropriate treatment. Lack of transportation and delayed careseeking also contributed to avoidable maternal deaths. The quality of medical records was very poor. Nearly 73.5% of maternal deaths were of rural residents and 20.5% of those who died were under the age of 18, which shows that young girls and rural residents carry significant maternal death risk. Conclusions: Maternal deaths are not properly documented in health facilities. Improper care led to avoidable maternal death. Improving care and information systems is crucial to making pregnancy safer and reducing maternal death.

Know-how of primary eye care among Health Extension Workers (HEWs) in Southern Ethiopia

Background/ Aim: Frontline health personnel can play key role in preventing and controlling blindness if they have good understanding of primary eye care (PEC). This study determined knowledge, attitude and practice of PEC among health extension workers (HEWs) in southern Ethiopia. Methods: A cross sectional community based study was conducted between June and July 2007 in five randomly selected woredas of Gurage Zone. Quantitative data were collected using a questionnaire completed in a face-faceinterview with 111 HEWs. And this was supported with qualitative information from two focus group discussions. Result: HEWs (87%) had poor understanding of the functional definition of blindness. They identified cataract (85%), trachoma (96%) and trauma (64%) as causes of blindness. Although most (89%) correctly mentioned signs and symptoms of trachoma, but only 10% could describe its control strategy. Refractive error was wrongly perceived by most (77%) as only a near vision problem. Glaucoma was barely known but causes of childhood blindness were well identified.. Their main source of information for eye health care was pre-service training (50%) and refresher trainings by international organizations (46%). HEWs practiced mainly preventive aspects of PEC. Group discussions revealed that HEWs have good will to participate in PEC but barriers such as inadequate knowledge and lack of basic suppliesare limiting their contribution. Conclusion: Know-how of blinding eye disease among HEWs is too low to enable them contribute meaningfullytowards prevention of blindness. It is recommended that PEC be incorporated in their training curriculum

High utility of active tuberculosis case finding in an Ethiopian prison

SETTING: Hawassa Prison, Southern Region of Ethiopia. OBJECTIVE: To determine the burden of pulmonary tuberculosis (TB) using active case finding among prisoners. DESIGN: In this cross-sectional study, prisoners were screened for TB using a symptom screen. Those with cough of 2 weeks had spot and morning sputum samples collected for acid-fast bacilli (AFB) smear microscopy and molecular diagnostic testing (Xpert® MTB/RIF). RESULTS: Among 2068 prisoners, 372 (18%) had a positive cough screen. The median age of these 372 persons was 23 years, 97% were male and 63% were from urban areas. Among those with a positive symptom screen, 8 (2%) were AFB sputum smear-positive and 31 (8%) were Xpert-positive. The point prevalence of pulmonary TB at the prison was 1748 per 100 000 persons. In multivariate analysis, persons with cough >4 weeks were more likely to have TB (OR 3.34, 95%CI 1.54–7.23). CONCLUSION: A high prevalence of TB was detected among inmates at a large Ethiopian prison. Active case finding using a cough symptom screen in combination with Xpert had high utility, and has the potential to interrupt transmission of Mycobacterium tuberculosis in correctional facilities in low- and middle-income, high-burden countries

Visceral leishmaniasis patients display altered composition and maturity of neutrophils as well as impaired neutrophil effector functions

Immunologically, active visceral leishmaniasis (VL) is characterised by profound immunosuppression, severe systemic inflammatory responses and an impaired capacity to control parasite replication. Neutrophils are highly versatile cells, which play a crucial role in the induction as well as the resolution of inflammation, the control of pathogen replication and the regulation of immune responses. Neutrophil functions have been investigated in human cutaneous leishmaniasis, however, their role in human visceral leishmaniasis is poorly understood. In the present study we evaluated the activation status and effector functions of neutrophils in patients with active VL and after successful anti-leishmanial treatment. Our results show that neutrophils are highly activated and have degranulated; high levels of arginase, myeloperoxidase and elastase, all contained in neutrophils’ granules, were found in the plasma of VL patients. In addition, we show that a large proportion of these cells are immature. We also analysed effector functions of neutrophils that are essential for pathogen clearance and show that neutrophils have an impaired capacity to release neutrophil extracellular traps, produce reactive oxygen species and phagocytose bacterial particles, but not Leishmania parasites. Our results suggest that impaired effector functions, increased activation and immaturity of neutrophils play a key role in the pathogenesis of VL

Revision of the Ethiopian Essential Health Service Package: An Explication of the Process and Methods Used

To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations’ needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia’s EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms.publishedVersio

Crop varieties research and implications on closing yield gaps and diversifying incomes—Africa RISING experiences

United States Agency for International Developmen

Risk factors of visceral leishmaniasis: a case control study in north-western Ethiopia

Background Visceral leishmaniasis (VL, also called “kala-azar”), is a life threatening neglected tropical infectious disease which mainly affects the poorest of the poor. VL is prevalent in Ethiopia particularly in the northwest of the country. Understanding the risk factors of VL infection helps in its prevention and control. The aim of the present study was to identify the factors associated with VL. Methods A case–control study was carried out during the period of January-July 2013 in northwest Ethiopia. Cases and controls were diagnosed using clinical presentation, the rk39 rapid diagnostic test and Direct Agglutination Test (DAT). A total of 283 (84.8% males versus 15.2% females) participants were interviewed. 90 cases and 193 controls were involved, matched by age, sex and geographical location with a ratio of 1:2 (case: controls). Univariate and backward multivariate conditional logistic regression were used to identify risk factors of VL. Results Elevated odds of VL was associated with goat ownership (OR = 6.4; 95%: confidence interval [Cl]: 1.5-28.4), living in houses with cracked wall (OR = 6.4; 95% Cl: 1.6-25.6), increased family size (OR = 1.3; 95% Cl: 1.0-1.8) and the number of days spent in the farm field (OR = 1.1; 95% Cl: 1.0-1.2). However, daily individual activities around the home and farm fields, mainly sleeping on a bed (OR = 0.2; 95%: Cl 0.03-0.9), sleeping outside the house under a bed net (OR = 0.1; 95% Cl: 0.02-0.36)] and smoking plant parts in the house during the night time (OR = 0.1; 95% Cl: 0.01-0.6) were associated with decreased odds of being VL case. Conclusion Our findings showed that use of bed net and smoke could be helpful for the prevention of VL in the area particularly among individuals who spend most of their time in the farm. VL control effort could be focused on improving housing conditions, such as sealing cracks and crevices inside and outside houses. Further research is warranted to elucidate the role of goats in the transmission of L. donovani, assess the impact of bed nets and the role of the traditional practice of smoking plants

Sodium Stibogluconate (SSG) & Paromomycin Combination Compared to SSG for Visceral Leishmaniasis in East Africa: A Randomised Controlled Trial

Visceral leishmaniasis (VL) is a parasitic disease with about 500,000 new cases each year and is fatal if untreated. The current standard therapy involves long courses, has toxicity and there is evidence of increasing resistance. New and better treatment options are urgently needed. Recently, the antibiotic paromomycin (PM) was tested and registered in India to treat this disease, but the same dose of PM monotherapy evaluated and registered in India was not efficacious in Sudan. This article reports the results of a clinical trial to test the effectiveness of injectable PM either alone (in a higher dose) or in combination with sodium stibogluconate (SSG) against the standard SSG monotherapy treatment in four East African countries—Sudan, Kenya, Ethiopia and Uganda. The study showed that the combination of SSG &PM was as efficacious and safe as the standard SSG treatment, with the advantages of being cheaper and requiring only 17 days rather than 30 days of treatment. In March 2010, a WHO Expert Committee recommended the use of the SSG & PM combination as a first line treatment for VL in East Africa