Predictors of Nutritional Status and Mortality of Children in Southern Ethiopia

Ethiopia is one of the poorest nations in the world with high prevalence of child mortality and under nutrition. Despite progress made in reducing stunting among children in the nation, child malnutrition and deaths are still high. In addition to the deep rooted poverty, recurrent drought and crop failures did aggravate the situation and international interventions were primarily targeted at provision of emergency food aid which couldn’t solve the problem in the long run. However, during the past decade, Ethiopia did attained significant economic development. The growing economy is expected contribute to reduction in child under nutrition and mortality. Yet, limited studies have been done reporting specific magnitude of child under nutrition and mortality across regions in the nation.   Therefore, there is a need to assess current level of child death and under nutrition as well as possible predictors of the problem. In this study, we conducted household survey together with anthropometric measurement of mothers and children in a remote drought prone farming community in Oromiya region of Southern Ethiopia. Results of our study indicated high prevalence of child under nutrition in the study area. We also found sever problem of drinking water in the study area. In addition, diarrhoea and child deaths were also widespread. Such factors like age of children, nutritional status of mothers, and number of child births, household economic status and polygamy appear to predict nutritional status and deaths of children. Thus, we conclude that more efforts need to be done to meet development needs of marginal communities so that  the problem of child under nutrition and mortality can be addressed in the nation. Keywords: Anthropometry, Child Death, under nutrition, Southern Ethiopi

Incidence and Predictors of Mortality among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at Debre Markos Referral Hospital, Northwest Ethiopia

BACKGROUND፡ Prematurity is the most frequent cause of neonatal death and the second leading cause of under-five mortality. Preterm related complications accounts for 35 % of neonatal deaths within the first week after birth. So far, most studies done in Ethiopia have focused on estimating the prevalence and determinant factors of premature neonatal death. The current study aimed to assess the incidence and predictors of mortality among preterm neonates admitted to neonatal intensive care unit at Debre Markos Referral Hospital.METHODS: An institution-based retrospective follow up study was conducted among premature neonates admitted to Neonatal Intensive Care Unit at Debre Markos Referral Hospital from July 2019 to October 2019. Around 498 patients were selected randomly. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.RESULTS: A total of 498 preterm babies were followed, and the mean age for follow up at the time of admission to NICU was 15 hours ± 38 SD. Death rate in preterm was estimated to be 27.11% (95% CI: 23.3%, 31.1%). Preterm neonates with gestational age of less than 32 weeks (AHR=1.51; 95% CI: 1.02, 2.24), respiratory distress syndrome (AHR=1.49; 95% CI: 1.03, 2.17), perinatal asphyxia (AHR=1.74, 95% CI: 1.01, 2.76) and congenital malformation (AHR=3.38, 95% CI: 1.21, 8.77) were statistically significant predictors of mortality among preterms.Conclusion: The incidence of death in preterm neonates is relatively low. Gestational age less than 32 weeks, perinatal asphyxia, respiratory distress syndrome and congenital malformation were found as predictors

Spatial distribution of Glossina sp. and Trypanosoma sp. in south-western Ethiopia

Background Accurate information on the distribution of the tsetse fly is of paramount importance to better control animal trypanosomosis. Entomological and parasitological surveys were conducted in the tsetse belt of south-western Ethiopia to describe the prevalence of trypanosomosis (PoT), the abundance of tsetse flies (AT) and to evaluate the association with potential risk factors. Methods The study was conducted between 2009 and 2012. The parasitological survey data were analysed by a random effects logistic regression model, whereas the entomological survey data were analysed by a Poisson regression model. The percentage of animals with trypanosomosis was regressed on the tsetse fly count using a random effects logistic regression model. Results The following six risk factors were evaluated for PoT (i) altitude: significant and inverse correlation with trypanosomosis, (ii) annual variation of PoT: no significant difference between years, (iii) regional state: compared to Benishangul-Gumuz (18.0 %), the three remaining regional states showed significantly lower PoT, (iv) river system: the PoT differed significantly between the river systems, (iv) sex: male animals (11.0 %) were more affected than females (9.0 %), and finally (vi) age at sampling: no difference between the considered classes. Observed trypanosome species were T. congolense (76.0 %), T. vivax (18.1 %), T. b. brucei (3.6 %), and mixed T. congolense/vivax (2.4 %). The first four risk factors listed above were also evaluated for AT, and all have a significant effect on AT. In the multivariable model only altitude was retained with AT decreasing with increasing altitude. Four different Glossina species were identified i.e. G. tachinoides (52.0 %), G. pallidipes (26.0 %), G.morsitans submorsitans (15.0 %) and G. fuscipes fuscipes (7.0 %). Significant differences in catches/trap/day between districts were observed for each species. No association could be found between the tsetse fly counts and trypanosomosis prevalence. Conclusions Trypanosomosis remains a constraint to livestock production in south-western Ethiopia. Four Glossina and three Trypanosoma species were observed. Altitude had a significant impact on AT and PoT. PoT is not associated with AT, which could be explained by the importance of mechanical transmission. This needs to be investigated further as it might jeopardize control strategies that target the tsetse fly population

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 >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <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 & 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

Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990–2019: results from the Global Burden of Disease Study 2019

Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Findings Globally, in 2019, among HIV-negative individuals, there were 1.18 million (95% uncertainty interval 1.08-1.29) deaths due to tuberculosis and 8.50 million (7.45-9.73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1.15 million (1.01-1.32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1.01 million (0.82-1.23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1.5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4.27 (3.69-5.02), 6.17 (5.48-7.02), and 1.17 (1.07-1.28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2.23 (2.03-2.44) times greater among males than females, whereas the fraction due to unsafe sex was 1.06 (1.05-1.08) times greater among females than males. Interpretation As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestone

The Role of Private Health Sector for Tuberculosis Control in Debre Markos Town, Northwest Ethiopia

Background. Tuberculosis has been declared to be a global epidemic. Despite all the effort, only less than half the annual estimated cases are reported by health authorities to the WHO. This could be due to poor reporting from the private sector. In Ethiopia, tuberculosis has also been a major public health problem. The aim of this study was to assess the role of the private health sector in tuberculosis control in Debre Markos. Methods. An institution based cross-sectional descriptive study was carried out in private health facilities. A total of 260 tuberculosis suspects attending the private clinics were interviewed. Focus group discussion, checklist, and structured questionnaire were used. Results. Majority of the private clinics were less equipped, poorly regulated, and owned by health workers who were self-employed on a part-time basis. Provider delay of 4 and more months was significantly associated higher likelihood of turning to a private provider (OR = 2.70, 95% CI = (1.20, 6.08)). Conclusions and Recommendations. There is significant delay among tuberculosis patients. Moreover, there is poor regulation of the private health sector by public health authorities. The involvement of the private sector in tuberculosis control should be limited to identification and refer to tuberculosis cases and suspects

Prevalence and antimicrobial susceptibility pattern of Salmonella and Shigella among food handlers in catering establishments at Debre Markos University, Northwest Ethiopia

Background: Food-borne diseases are a major health problem in developing countries including Ethiopia. This study determined the prevalence and antibiotic susceptibility patterns of Shigella and Salmonella among food handlers working in student and staff food service establishments at Debre Markos University. Methods: A laboratory-based cross-sectional study was conducted among 220 food handlers from January 2015 to June 2016. Stool and fingernail samples from the subjects were cultured on bacteriological culture medium, and Shigella and Salmonella were isolated and identified following standard procedures. Antimicrobial susceptibility testing was performed for all isolates using the Kirby–Bauer disk diffusion method. Results: The overall prevalence of Shigella and Salmonella in this study was 5.9%, with 3.6% of stool specimens testing positive for Salmonella species and 2.3% testing positive for Shigella species. None of the food handlers had positive cultures for Shigella or Salmonella in respect of their fingernail specimens. The isolation of either Shigella or Salmonella had a significant inverse relationship with the number of service years (p = 0.017). All isolates of Shigella and Salmonella were 100% susceptible to ciprofloxacin, norfloxacin, and gentamicin. However, all isolated pathogens were resistant to ampicillin (100%). Conclusions: The findings of this study highlight the importance of food handlers in the transmission of pathogens to the customers (students and the general population). Screening of food handlers, training for food handling and hand hygiene practices, and regular monitoring of the food handling practices should be done in order to avoid diseases that can be acquired through improper food handling, like bacterial infections. Keywords: Food handlers, Salmonella, Shigella, Antimicrobial susceptibility, Ethiopi