Predictors of mortality among under-five children with severe acute malnutrition,Northwest Ethiopia: an institution based retrospective cohort study

Background

Globally, approximately 19 million children under 5 years are suffering from Severe Acute Malnutrition (SAM). It is a major cause of morbidity and mortality in low-income countries including Ethiopia. However, little is known regarding predictors of mortality among these children in Ethiopia. The current study aimed to assess the potential predictors of mortality among under-five children with SAM admitted to a stabilization center.

Method

A retrospective cohort study was conducted in 527 under-five children who were admitted for SAM at the University of Gondar comprehensive specialized hospital from 2014 to 2016. Data were collected from a randomly selected chart after getting ethical clearance. Data were cleaned, coded and entered to Epi-info (version 7) and analyzed using STATA (version14). The outcome was computed by using tables and graphs. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.

Result

Overall, the median follow-up period was 10 days with interquartile range (Q1, Q3: 8, 17). At the end of the follow-up, the mortality rate was 66(12.52%). Anemia (AHR(Adjusted Hazard Ratio): 2.3, 95% CI: 1.2, 4.5), Shock (AHR: 7.9, 95% CI: 3.7, 16.7), no intake of antibiotics (AHR: 2.3 95% CI: 1.2, 4.4), IV-Fluid (AHR: 3.2, 95% CI: 1.7, 5.8), no intake of F75 (AHR: 6.6,95% CI: 2.9, 14.7) and no intake of F100 (AHR: 3, 95% CI: 1.6, 5.4) were independent predictors of mortality.

Conclusion

The survival status of under-five children with SAM was lower than the national standard protocol. Altered general conditions such as shock, anemia, not adhering to medical and nutritional therapies were identified as predictors of mortality among SAM children. Health education on early medical seeking behavior and adherence on the routine regimens may improve this gap in child survival.

     

IFN‐γ against the 38‐kDa antigen of Mycobacterium tuberculosis discriminates pulmonary tuberculosis from infection and infection from exposure: evidence from a study of human population in a high endemic setting

Mycobacterium tuberculosis (Mtb) 38‐kDa antigen is an immunogenic lipoprotein that induces strong T‐cell responses in experimental animals. However, there is limited information on the role of this antigen in human population. In this article, we present the dynamics of pro‐inflammatory (IFN‐γ and TNF‐α) and anti‐inflammatory cytokine (IL‐10) against the 38 kDa in cohorts of pulmonary TB (PTB) patients, household contacts (HHCs), and community controls (CCs) in a high endemic setting. Whole blood assay was used to determine the levels of cytokines in 149 patients, 149 HHCs, and 68 CCs at baseline, 6 months, and 12 months. At baseline, the level of IFN‐γ was significantly (p < 0.0001) higher in CCs and HHCs than in untreated patients. CCs had significantly (p < 0.05) higher level of IFN‐γ than HHCs. There was no significant difference between treated and untreated patients, and there was no significant change in HHCs over 12 months. At baseline, the levels of IL‐10 and TNF‐α were significantly (p < 0.0001) higher in patients than in HHCs and CCs. No significant change was observed between treated patients and untreated patients and HHCs over time. The study shows that IFN‐γ against the 38 kDa discriminates clinical TB from infection and infection from exposure, suggesting its potential for immune protection and diagnosis.     

Prevalence of Helicobacter pylori infection among adult dyspeptic patients in Ethiopia

In developing countries such as Ethiopia, where chronic gastritis and peptic-ulcer disease are the most common endoscopic findings, it is important to study the association between Helicobacter pylori infection and gastroduodenal diseases. Both invasive and non-invasive diagnostic methods were therefore used to investigate 300, consecutive, adult patients with dyspepsia, from the gastrointestinal clinic of Tikur Anbassa University Hospital, Addis Ababa. The apparent overall prevalence of H. pylori infection varied according to the detection method employed. Culture revealed H. pylori in only 69% of the patients but this pathogen appeared more common when rapid urease tests (71%), PCR-denaturating gradient gel electrophoresis (91%), histopathology (81%), silver staining (75%) or stool-antigen tests (81%) were employed. Antibodies to H. pylori were detected, both by enzyme immuno-assay (EIA) and immunoblotting, in approximately 80% of the patients, whether the antigens used were of a reference strain or from a local isolate of H. pylori. When some of the EIA-positive and EIA-negative sera were cross-absorbed with antigens of Campylobacter jejuni and re-tested by EIA, the H. pylori-positive sera remained positive and the negative sera remained negative. Dyspeptic patients in Ethiopia, like most of those previously observed elsewhere in Africa, are often infected with H. pylori. It is important that the management of these patients should not be hampered by the misinterpretation of the African epidemiology of this pathogen.     

Distribution of anopheline mosquitoes in Eritrea

The spatial distribution of anopheline mosquito species was studied throughout Eritrea during the 1999-2001 malaria transmission seasons from October to December for the highlands and western lowlands and February to April for the coastal region. Of the 302 villages sampled, 59 were visited in both the first and second year. Overall, 13 anopheline species were identified, with the Anopheles gambiae complex predominating during the first year (75.6%, n = 861) and the second year (91.9%, n = 1,262). Intrazonal variation accounted for 90% of the total variation in mosquito distribution. Polymerase chain reaction results indicated that 99% (n = 1,309) of the An. gambiae s.l. specimens were An. arabiensis, indicating that this was the only member of the gambiae complex present. There was a high degree of aggregation of anophelines within zones and villages, with more than 80% of the total anophelines being collected from less than 20% of the villages and from only 10% of the houses sampled. At least 80% of the anopheline mosquitoes were collected from grass-thatched Agudo-type housing. Vector abundance showed an inverse relationship with elevation, with highest densities in the low-lying western lowlands. Multiple regression analysis of log-transformed mean density of An. arabiensis with rainfall and the normalized difference vegetation index (NDVI) (average NDVI, minimum NDVI, and maximum NDVI) showed that these independent variables were not significantly associated with mosquito densities (R2 = 0.058). Our study contributes to the basic understanding of the ecology and distribution of malaria vectors with respect to species composition and spatial heterogeneities both that could be used to guide vector control operations in Eritrea.     

Changes in the antigenic profile of Leishmania parasites following shifts in temperature.

We have examined by immunoblotting the antigen profiles of Leishmania parasites which have undergone upward shifts in ambient temperature during culture. Parasites in the promastigote insect vector stage were grown to stationary growth phase at 25 degrees C, and then further cultured at the 37 degrees C temperature experienced in the mammalian host. Changes in the immunoblot profiles of the parasites occurred within one day of culture at mammalian ambient temperature. Serum antibodies from patients with active Leishmania infections showed reactivity with antigenic determinants of greater than Mr 38,000 that were expressed by parasites at 37 degrees C, and which were not comparably observed on immunoblots of 25 degrees C cultured organisms. The promastigotes of Leishmania species which cause either cutaneous or visceral leishmaniasis express differing forms of the 37 degrees C induced high molecular weight determinants, however, these molecules express cross-reactive epitopes. Previous studies have suggested that temperature may play a role in the differentiation process between the insect and host life cycle stages of Leishmania. Our results suggest that the antigenic profile of Leishmania parasites may also be affected by the expression of products from temperature sensitive biosynthetic pathways.     

Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region,Ethiopia

Background  

Afar pastoralists live in the northeast of Ethiopia, confined to the most arid part of the country, where there is least access to educational, health and other social services. Tuberculosis (TB) is one of the major public health problems in Afar region. Lack of knowledge about TB could affect the health-seeking behaviour of patients and sustain the transmission of the disease within the community. In this study, we assessed the knowledge and perception of apparently healthy individuals about pulmonary tuberculosis (PTB) in pastoral communities of Afar.