One health research ethics

Emerging and re-emerging infectious diseases (EIDs) present major threats to public health, global security, and economic development. Coronavirus disease 2019 (COVID-19) is the latest EID to demonstrate the devastation, suffering, and scale of death that an EID can cause. Pandemics involving emerging and re-emerging infectious agents and associated infectious diseases, climate change, urbanization, biodiversity loss and financial instability have been identified as the most critical global issues today (1). Close to three-quarters of today’s EIDs are known to be of zoonotic origin (where infectious agents spread to humans from domestic or wild animals), and their frequency and economic impact are on the ris

High enteric bacterial contamination of drinking water in Jigjiga city, Eastern Ethiopia

Background: The high prevalence of diarrheal disease among children and infants can be traced due to the use of unsafe water and unhygienic practices. The overall concept adopted for microbiological quality is that no water intended for human consumption shall contain Escherichia coli per 100 ml sample.Objective: The aim of this study was to assess household water handling and hygienic practices and to determine bacteriological quality of drinking water from different sources in Jigjiga city.Methods: A cross-sectional study was conducted to assess bacteriological quality of drinking water in Jigjiga city from May-August, 2013. Both simple random and convenient sampling techniques were applied to select 238 households to assess water handling and hygienic practices, and 125 water samples to assess bacteriological quality of drinking water respectively. The water samples were collected from household water container, pipeline, water reservoir, ‘Beyollie’, and main sources.Easily isolated bacteria called coliforms were used as indicator organisms of human and other animals’ fecal contamination status of drinking water. Data were summarized using descriptive and analytical statistics. Chi-square (χ2) and logistic regression tests were used and p<0.05 was considered as cut off value for statistical significance.Results: Overall, 71.2%(n=89) of water samples were contaminated by one or more bacterial species of E.coli, Shigella Sp, Salmonella Sp, and Vibrio sp. Particularly, 65(52%), 10(8%), 9(7.2%), and 8(6.4%) were contaminated by E.coli, Shigella sp, Salmonella sp, and Vibrio sp, respectively. On the other hand, 20% of the households and pipeline water samples had a fecal coliform count of 150 and above. Placement of water drinking utensils had a statistically significant association with illiterate education (p=0.01, AOR=5.47, 95% CI: (1.31, 22.78)) and male household head (p=0.02, AOR=2.11, 95% CI: (1.10, 4.05)).Conclusions: The majorities of drinking water sources were highly contaminated by Enterobacteriaceae. Regular bacteriological water quality control mechanisms need to be in place to ensure bacteriological safety of drinking water. [Ethiop. J. Health Dev. 2016;30(3):118-128]Keywords: Contamination, drinking water, households, enteric bacteria, Jigjig

Nursing Students’ English Language Learning Needs and Perceptions

Nursing students should learn English language courses which focus on a restricted range of skills required by them for their profession. Cognizant of this, the researchers in this study surveyed specific English language needs of undergraduate nursing students. The study used Hutchinson and Waters' (1987) approach to analyze nursing students’ needs of English language skills and sub-skills to study their field effectively, their level of proficiency in English language skills and their perceptions of the relevance of the courses offered to them. To collect data, questionnaire and interview were used. The results showed that students are more proficient in reading and writing about health related issues than speaking and listening. Students reported that they could read and understand medical texts, instruments and reports written by doctors. It was also found out that students could write patient history, prescriptions and medication procedures. The study concluded that the courses which nursing students are taking are irrelevant. There is need to design specific courses which improve their reading and writing skills in their field. Key words: field related courses, needs analysis, profession, read medical articles, writing about health related issues,

Genotype characterization of Epstein–Barr virus among adults living with human immunodeficiency virus in Ethiopia

BackgroundEpstein–Barr virus (EBV) is a human lymphotropic herpesvirus with a causative agent in cancer. There are two genotypes of EBV (EBV genotype 1 and EBV genotype 2) that have been shown to infect humans. This study aimed to characterize the EBV genotype among people with human immunodeficiency virus (PWH) and HIV-negative individuals in Ethiopia.MethodsDNA was extracted from peripheral blood mononuclear cells (PBMCs). Conventional polymerase chain reaction (cPCR) targeting EBNA3C genes was performed for genotyping. A quantitative real-time PCR (q-PCR) assay for EBV DNA (EBNA1 ORF) detection and viral load quantification was performed. Statistical significance was determined at a value of p < 0.05.ResultIn this study, 155 EBV-seropositive individuals were enrolled, including 128 PWH and 27 HIV-negative individuals. Among PWH, EBV genotype 1 was the most prevalent (105/128, 82.0%) genotype, followed by EBV genotype 2 (17/128, 13.3%), and mixed infection (6/128, 4.7%). In PWH, the median log10 of EBV viral load was 4.23 copies/ml [interquartile range (IQR): 3.76–4.46], whereas it was 3.84 copies/ml (IQR: 3.74–4.02) in the HIV-negative group. The EBV viral load in PWH was significantly higher than that in HIV-negative individuals (value of p = 0.004). In PWH, the median log10 of EBV viral load was 4.25 copies/ml (IQR: 3.83–4.47) in EBV genotype 1 and higher than EBV genotype 2 and mixed infection (p = 0.032).ConclusionIn Ethiopia, EBV genotype 1 was found to be the most predominant genotype, followed by EBV genotype 2. Understanding the genotype characterization of EBV in PWH is essential for developing new and innovative strategies for preventing and treating EBV-related complications in this population

Advances in the diagnosis, treatment and control of HIV associated tuberculosis

There has been an increase in the number of published tuberculosis/HIV (TB/HIV) research findings in recent times. The potential impact of these findings on routine care has informed this review which aims at discussing current concepts and practices underpinning TB/HIV care and control. Diagnosis: Any HIV infected person with a cough of any duration is currently considered a TB suspect. Preliminary results also show that the diagnostic yield of same day sputum samples (front loading) is comparable to two day samples. Laboratory diagnosis is shifting from Ziehl–Neelsen (ZN) smear microscopy and solid culture to fluorescent microscopy, molecular tests and liquid culture. Treatment: Concomitant TB/HIV therapy improves survival and WHO has recommended ART for all TB/HIV patients. Unless CD4 cell counts are less 50 cells/µl, ART can be deferred until end of intensive phase. Evidence of survival benefit at high CD4 cell counts is still lacking. New TB drugs and treatment shortening studies are underway but so far no new TB drugs has been added to the current arsenal and treatment duration still remains six months or more. TB control: WHO has recommended the 3Is (intensified TB case finding, isoniazid prophylaxis and infection control) for TB/HIV control in addition to effective therapy, Antiretroviral therapy and TB vaccines. Conclusion: There has been immense progress in TB/HIV research, however optimal management of HIV-Infected TB patients, will require further research and appropriate translation of emerging evidence to policy and practice

Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-group Prospective Cohort Study in two sub-Saharan Africa Populations.

We evaluated the importance of ethnicity and pharmacogenetic variations in determining efavirenz pharmacokinetics, auto-induction and immunological outcomes in two African populations. ART naïve HIV patients from Ethiopia (n = 285) and Tanzania (n = 209) were prospectively enrolled in parallel to start efavirenz based HAART. CD4+ cell counts were determined at baseline, 12, 24 and 48 weeks. Plasma and intracellular efavirenz and 8-hydroxyefvairenz concentrations were determined at week 4 and 16. Genotyping for common functional CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 variant alleles were done. Patient country, CYP2B6*6 and ABCB1 c.4036A>G (rs3842A>G) genotype were significant predictors of plasma and intracellular efavirenz concentration. CYP2B6*6 and ABCB1 c.4036A>G (rs3842) genotype were significantly associated with higher plasma efavirenz concentration and their allele frequencies were significantly higher in Tanzanians than Ethiopians. Tanzanians displayed significantly higher efavirenz plasma concentration at week 4 (p<0.0002) and week 16 (p = 0.006) compared to Ethiopians. Efavirenz plasma concentrations remained significantly higher in Tanzanians even after controlling for the effect of CYP2B6*6 and ABCB1 c.4036A>G genotype. Within country analyses indicated a significant decrease in the mean plasma efavirenz concentration by week 16 compared to week 4 in Tanzanians (p = 0.006), whereas no significant differences in plasma concentration over time was observed in Ethiopians (p = 0.84). Intracellular efavirenz concentration and patient country were significant predictors of CD4 gain during HAART. We report substantial differences in efavirenz pharmacokinetics, extent of auto-induction and immunologic recovery between Ethiopian and Tanzanian HIV patients, partly but not solely, due to pharmacogenetic variations. The observed inter-ethnic variations in efavirenz plasma exposure may possibly result in varying clinical treatment outcome or adverse event profiles between populations

Skin prick reactivity among asthmatics in East Africa

Background: The burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa. Methods: From August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined. Results: Of the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics. Conclusion: There is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study. Trial registration: The ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017

Conceptualising centres of excellence: a scoping review of global evidence

Objective- Globally, interest in excellence has grown exponentially, with public and private institutions shifting their attention from meeting targets to achieving excellence. Centres of Excellence (CoEs) are standing at the forefront of healthcare, research and innovations responding to the world’s most complex problems. However, their potential is hindered by conceptual ambiguity. We conducted a global synthesis of the evidence to conceptualise CoEs. Design- Scoping review, following Arksey and O’Malley’s framework and methodological enhancement by Levac et al and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Data sources- PubMed, Scopus, CINAHL, Google Scholar and the Google engine until 1 January 2021. Eligibility- Articles that describe CoE as the main theme. Results- The search resulted in 52 161 potential publications, with 78 articles met the eligibility criteria. The 78 articles were from 33 countries, of which 35 were from the USA, 3 each from Nigeria, South Africa, Spain and India, and 2 each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece and Peru. The rest 17 were from various countries. The articles involved six thematic areas—healthcare, education, research, industry, information technology and general concepts on CoE. The analysis documented success stories of using the brand ‘CoE’—an influential brand to stimulate best practices. We identified 12 essential foundations of CoE—specialised expertise; infrastructure; innovation; high-impact research; quality service; accreditation or standards; leadership; organisational structure; strategy; collaboration and partnership; sustainable funding or financial mechanisms; and entrepreneurship. Conclusions- CoEs have significant scientific, political, economic and social impacts. However, there are inconsistent use and self-designation of the brand without approval by an independent, external process of evaluation and with high ambiguity between ‘CoEs’ and the ordinary ‘institutions’ or ‘centres’. A comprehensive framework is needed to guide and inspire an institution as a CoE and to help government and funding institutions shape and oversee CoEs