Potential for integrated control of neglected tropical diseases in Ethiopia

Ethiopia is one of the poorest and least developed countries in the world, endemic for many neglected tropical diseases (NTDs). The Ministry of Health is successfully controlling onchocerciasis through community-directed treatment with ivermectin and has implemented health system changes that would allow extension of integrated NTD control to schistosomiasis, lymphatic filariasis, soil-transmitted helminthiasis and trachoma. Funds are now needed to gain a better understanding of the endemicity and co-endemicity of these diseases and to formulate and pilot integrated packages for mass drug administration (MDA). Based on the experience gained, MDA may then be scaled-up to all NTD-endemic areas.     

The prevalence of epilepsy in the Zay Society, Ethiopia--an area of high prevalence.

Very high prevalence rates of epilepsy have been found in some developing countries. The Zay Society of Ethiopia was screened for epilepsy during a door-to-door survey and after neurological assessment, a prevalence of 29.5/1000 was found. Almost all the cases had primary generalised epilepsy in contrast to the predominance of partial epilepsy found elsewhere. Due to its historical isolation, epilepsy genes may have become widely disseminated throughout the Zay Society, accounting for the elevated prevalence.     

Temporal and Spatial Patterns and a Space–Time Cluster Analysis of Foot-and-Mouth Disease Outbreaks in Ethiopia from 2010 to 2019

Foot-and-mouth disease (FMD) is an endemic disease in Ethiopia, although space–time cluster and monthly variation studies have never been assessed at national level. The current study aimed to identify the spatial and temporal distribution of FMD outbreaks in Ethiopia from national outbreak reports over a period of ten years from 1 January 2010 to 31 December 2019. To this end, a total of 376,762 cases and 1302 outbreaks from 704 districts were obtained from the Minister of Agriculture for analyses. In general, the dry periods, i.e., October to March, of the year were recorded as the peak outbreak periods, with the highest prevalence in March 2012. The monthly average and the outbreak trends over ten years show a decrease of outbreaks from 2010 to 2019. Decomposing the FMD outbreak data time series showed that once an outbreak erupted, it continued for up to five years. Only 12% of the reported outbreaks were assigned to a specific serotype. Within these outbreaks, the serotypes O, A, SAT-2, and SAT-1 were identified in decreasing order of prevalence, respectively. When a window of 50% for the maximum temporal/space cluster size was set, a total of seven FMD clusters were identified in space and time. The primary cluster with a radius of 380.95 km was identified in the southern part of Ethiopia, with a likelihood ratio of 7.67 (observed/expected cases). The third cluster, with a radius of 144.14 km, was identified in the northeastern part of the country, and had a likelihood ratio of 5.66. Clusters 1 and 3 occurred from January 2017 to December 2019. The second cluster that occurred had a radius of 294.82 km, a likelihood ratio of 6.20, and was located in the central and western parts of Ethiopia. The sixth cluster, with a radius of 36.04 km and a likelihood ratio of 20.60, was set in southern Tigray, bordering Afar. Clusters 2 and 6 occurred in the same period, from January 2014 to December 2016. The fourth cluster in northern Tigray had a calculated radius of 95.50 km and a likelihood ratio of 1.17. The seventh cluster occurred in the north-central Amhara region, with a radius of 97 km and a likelihood ratio of 1.16. Clusters 4 and 7 occurred between January 2010 and December 2013. The spatiotemporal and cluster analysis of the FMD outbreaks identified in the context of the current study are crucial in implementing control, prevention, and a prophylactic vaccination schedule. This study pointed out October to March as well as the main time of the year during which FMD outbreaks occur. The area that extends from the south to north, following the central highlands, is the main FMD outbreak area in Ethiopia.     

Evaluation of Community-Based Trichiasis Surgery in Northwest Ethiopia

Background

Surgery to correct trachomatous trichiasis (TT) is recommended to prevent blindness caused by trachoma. This study evaluated the outcomes of community-based trichiasis surgery with absorbable sutures, conductd in Amhara Regional State, Ethiopia.

Methods

A simple random sample of 431 patients was selected from surgical campaign records of which 363 (84.2%) were traced and enrolled into the study. Participants were interviewed and examined for trichiasis recurrence, complications of TT surgery and corneal opacity. Multilevel logistic regression models were used to explore the associations between trichiasis recurrence, corneal opacity and explanatory variables at the eye level.

Results

The prevalence of trichiasis recurrence was 9.4% (95% Confidence Interval [CI] 6.6–12.8) and corneal opacity was found in 14.3% (95% CI 10.9–18.3) of the study participants. The proportion of participants with complications of TT surgery was: granuloma 0.6% (95% CI 0.1–2.0); lid closure defects 5.5% (95% CI 3.4–8.4) and lid notching 16.8% (95% CI 13.1–21.1). No factors were identified for trichiasis recurrence. Corneal opacity was associated with increased age (Ptrend=0.001), more than 12 months post surgery (OR=2.7; 95%CI 1.3–5.6), trichiasis surgery complications (OR=2.9; 95%CI 1.4–5.9) and trichiasis recurrence (OR=2.5; 95%CI 1.0–6.3).

Conclusion

Prevalence of recurrent trichiasis and granuloma were lower than expected but higher for lid closure defects and lid notching. The majority of the participants reported satisfaction with the trichiasis surgery they had undergone. The findings suggest that recurrence of trichiasis impacts on the patients'' risk of developing corneal opacity but longitudinal studies are required to confirm this.     

Heteronormativity and ‘troubled’ masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies ‘belonging’ to parents, families and to society at large.     

Assessment of Knowledge and Attitude towards Palliative Care and Associated Factors among Nurses Working in North Wollo Hospitals

BackgroundPalliative care improves the quality of life of patients facing a life-threatening illness. Nurses should improve their caregiving capacity. In Ethiopia, palliative care is underestimated. The availability of data regarding the knowledge and attitude of nurses towards palliative care is critically important. Thus, this study aimed to assess the level of knowledge and attitude of nurses towards palliative care.MethodsInstitution-based, cross-sectional study was conducted in North Wollo hospitals. A simple random sampling technique was used. The data was collected using structured self-administered questionnaires from February to March 2019. The analysis was done using a binary logistic regression model. P-value < 0.05 was considered as statistically significant.ResultsThe result revealed that 59.7% of the respondents had good knowledge and 44.2% had a favorable attitude towards palliative care. Level of education, experience in caring for chronically ill patients, and experience in caring for dying family members within the last 6 months had a significant association with the knowledge of nurses. Monthly income, experience in caring for chronically ill patients, formal palliative care education, and knowledge were found statistically significant with the attitude of nurses towards palliative care.ConclusionMore than half of the nurses had good knowledge, but less than half of the respondents had a favorable attitude towards palliative care. Attention should be given towards palliative care by the health policy and needs to be incorporated into the national curriculum of nursing education.