Food Safety Practice and Associated Factors of Food Handlers Working in Substandard Food Establishments in Gondar Town, Northwest Ethiopia, 2013/14

Introduction: Food borne illnesses comprise a broad spectrum of diseases and are responsible for substantial morbidity and mortality worldwide. The global incidence of food borne disease is difficult to estimate, but it has been reported that 2.1 million people died each year from diarrheal diseases and contaminated food contributes to 1.5 billion cases of diarrhea in children each year, resulting in more than three million premature deaths. In developing countries, up to an estimated 70% of cases of diarrheal diseases are associated with the consumption of contaminated foods. Approximately 10 to 20% of food-borne disease outbreaks are due to contamination by the food handler. Objective: This study was conducted to assess food safety practices and associated factors of food handlers working in substandard food establishments of Gondar town, Northwest Ethiopia, 2013/14. Methods: Institution based cross sectional study design was conducted to assess food safety practices and associated factors of food handlers. Four hundred three food handlers were taken randomly as study subjects and data were collected by observation by using standardized questionnaire and observational check lists. Ordinal logistic regression model was fitted to analyze the predictor variables. Results: The overall level of food safety practices (good – 30.30%, fair- 47.60% and poor – 22.10%) was reported. Of a number of predictor variables analyzed age, marital status, service year, monthly income, food hygiene and safety training, attitude, knowledge and depth of knowledge were identified as factors affecting food safety practices. Conclusion and recommendations: Compared to other similar studies, Low level of food safety practice (good – 30.30%, fair- 47.60% and poor – 22.10%) was reported. Therefore, Environmental health practitioners, the local Medias and the managers should do a lot to improve food safety practices of the food handlers. They should also design and implement food safety awareness creation programs

Status and determinants of poverty and income inequality in pastoral and agro-pastoral communities: Household-based evidence from Afar Regional State, Ethiopia

This paper analyzes poverty and its determinants and income inequality in pastoral and agro-pastoral communities in Ethiopia. 2295 households from zone 1 and zone 2 of the Afar region were surveyed and examined using the FGT index, the Gini coefficient, and logistic regression. 47.6 percent of the households are poor, with poverty gap index of 0.178 and poverty severity index of 0.092. Food poverty accounts for 33.7 percent with an income gap of Birr 33 per month. Food poverty is highest in pastoral (35.6%) than the agro-pastoral communities (29.8%). 35.6 percent of PSNP non-participants and 32 percent of the participant households are poor. Gender of the household head, family size, access to credit, mobility, participating in safety net programs and local institutions, distance to market and remittances are determining poverty in the area. There is an alarmingly high degree of income inequality (0.592) in the study area. The lowest Gini index (0.433) is found in Koneba district, and the highest index (0.616) is observed in widowed heads of households. Strengthening the poverty reduction programs and introducing diversified income schemes; modernizing local institutions, increase provision of microfinance services, introducing packages specific to women and youth are recommended to address the high poverty and inequality in Afar

Comparison of artemether-lumefantrine and chloroquine with and without primaquine for the treatment of Plasmodium vivax infection in Ethiopia: A randomized controlled trial

Background: Recent efforts in malaria control have resulted in great gains in reducing the burden of Plasmodium falciparum, but P. vivax has been more refractory. Its ability to form dormant liver stages confounds control and elimination efforts. To compare the efficacy and safety of primaquine regimens for radical cure, we undertook a randomized controlled trial in Ethiopia. Methods and findings: Patients with normal glucose-6-phosphate dehydrogenase status with symptomatic P. vivax mono-infection were enrolled and randomly assigned to receive either chloroquine (CQ) or artemether-lumefantrine (AL), alone or in combination with 14 d of semi-supervised primaquine (PQ) (3.5 mg/kg total). A total of 398 patients (n = 104 in the CQ arm, n = 100 in the AL arm, n = 102 in the CQ+PQ arm, and n = 92 in the AL+PQ arm) were followed for 1 y, and recurrent episodes were treated with the same treatment allocated at enrolment. The primary endpoints were the risk of P. vivax recurrence at day 28 and at day 42. The risk of recurrent P. vivax infection at day 28 was 4.0% (95% CI 1.5%–10.4%) after CQ treatment and 0% (95% CI 0%–4.0%) after CQ+PQ. The corresponding risks were 12.0% (95% CI 6.8%–20.6%) following AL alone and 2.3% (95% CI 0.6%–9.0%) following AL+PQ. On day 42, the risk was 18.7% (95% CI 12.2%–28.0%) after CQ, 1.2% (95% CI 0.2%–8.0%) after CQ+PQ, 29.9% (95% CI 21.6%–40.5%) after AL, and 5.9% (95% CI 2.4%–13.5%) after AL+PQ (overall p < 0.001). In those not prescribed PQ, the risk of recurrence by day 42 appeared greater following AL treatment than CQ treatment (HR = 1.8 [95% CI 1.0–3.2]; p = 0.059). At the end of follow-up, the incidence rate of P. vivax was 2.2 episodes/person-year for patients treated with CQ compared to 0.4 for patients treated with CQ+PQ (rate ratio: 5.1 [95% CI 2.9–9.1]; p < 0.001) and 2.3 episodes/person-year for AL compared to 0.5 for AL+PQ (rate ratio: 6.4 [95% CI 3.6–11.3]; p < 0.001). There was no difference in the occurrence of adverse events between treatment arms. The main limitations of the study were the early termination of the trial and the omission of haemoglobin measurement after day 42, resulting in an inability to estimate the cumulative risk of anaemia. Conclusions: Despite evidence of CQ-resistant P. vivax, the risk of recurrence in this study was greater following treatment with AL unless it was combined with a supervised course of PQ. PQ combined with either CQ or AL was well tolerated and reduced recurrence of vivax malaria by 5-fold at 1 y

Primaquine in vivax malaria: an update and review on management issues

Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. It has remained the only FDA licensed drug capable of clearing the intra-hepatic schizonts and hypnozoites of Plasmodium vivax. This update and review focuses on five major aspects of primaquine use in treatment of vivax malaria, namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use, c) critical analysis of reported resistance against primaquine containing regimens; d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance; and e) the potential for replacement of primaquine with newer drugs

Reduced Mitochondrial Membrane Potential is a Late Adaptation of Trypanosoma brucei brucei to Isometamidium Preceded by Mutations in the γ Subunit of the F1Fo- ATPase

Background: Isometamidium is the main prophylactic drug used to prevent the infection of livestock with trypanosomes that cause Animal African Trypanosomiasis. As well as the animal infective trypanosome species, livestock can also harbor the closely related human infective subspecies T. b. gambiense and T. b. rhodesiense. Resistance to isometamidium is a growing concern, as is cross-resistance to the diamidine drugs diminazene and pentamidine. Methodology/Principal Findings: Two isometamidium resistant Trypanosoma brucei clones were generated (ISMR1 and ISMR15), being 7270- and 16,000-fold resistant to isometamidium, respectively, which retained their ability to grow in vitro and establish an infection in mice. Considerable cross-resistance was shown to ethidium bromide and diminazene, with minor cross-resistance to pentamidine. The mitochondrial membrane potentials of both resistant cell lines were significantly reduced compared to the wild type. The net uptake rate of isometamidium was reduced 2-3-fold but isometamidium efflux was similar in wild-type and resistant lines. Fluorescence microscopy and PCR analysis revealed that ISMR1 and ISMR15 had completely lost their kinetoplast DNA (kDNA) and both lines carried a mutation in the nuclearly encoded γ subunit gene of F1 ATPase, truncating the protein by 22 amino acids. The mutation compensated for the loss of the kinetoplast in bloodstream forms, allowing near-normal growth, and conferred considerable resistance to isometamidium and ethidium as well as significant resistance to diminazene and pentamidine, when expressed in wild type trypanosomes. Subsequent exposure to either isometamidium or ethidium led to rapid loss of kDNA and a further increase in isometamidium resistance. Conclusions/Significance: Sub-lethal exposure to isometamidium gives rise to viable but highly resistant trypanosomes that, depending on sub-species, are infective to humans and cross-resistant to at least some diamidine drugs. The crucial mutation is in the F1 ATPase γ subunit, which allows loss of kDNA and results in a reduction of the mitochondrial membrane potential