Determinants of Incomplete Childhood Vaccination among Children Aged 12–23 Months in Gambela Region,Southwest Ethiopia: A Case Control Study

BackgroundChildhood vaccination is considered as one of the most cost-effective public health interventions. With an increasing dropout rate from vaccination, the factors for incomplete vaccination are not well explored. The objective of this study was to identify determinants of incomplete childhood vaccination.MethodCommunity based case-control study was conducted from March 1–30, 2018. Cases were children who missed at least one dose of routine vaccine while controls were children who completed all recommended doses. Face-to-face interviews were used to collect data. Multivariable logistic regression was performed in order to identify determinants with 95% CI and a p-value of <0.05.ResultA total of 93 cases and 185 controls were participated in the study. Not attending postnatal care [AOR=2.16, 95% CI: 1.08–4.28], household not visited by health workers [AOR=3.99, 95% CI: 2.13–7.48], postponing vaccination schedules [AOR = 6.15, 95% CI: 3.08–12.27], caretakers who had misconception of vaccination [AOR = 2.90, 95% CI: 1.53–5.52], unsatisfied care takers [AOR=1.970, 95% CI:1.04–3.74] and poor knowledge about vaccines [AOR = 2.33, 95% CI: 1.19–4.59] were determinants of incomplete childhood vaccination.ConclusionFailure to attend postnatal care, postponing vaccination schedules, having misconception for vaccine contraindication, households not visited by health workers, caretakers who had poor knowledge about vaccines and unsatisfied caretakers were determinants of incomplete childhood vaccination. Based on the finding, it is recommended that health education should be improved to decrease caretakers'' misconception, poor knowledge and postponement of the vaccine schedule. It is also recommended to increase health workers household visit.     

Severe Acute Malnutrition among Unoperated Ethiopian Children with Congenital Heart Disease: A Wake-up Call to Reverse the Situation,A Retrospective Cross-Sectional Study

BackgroundChildren with Congenital Heart Disease (CHD) are at increased risk for severe acute malnutrition (SAM). We aimed to determine the magnitude and determinants of SAM among children with CHD in a tertiary hospital.MethodsRetrospective cross-sectional study was conducted among children with CHD between 2016 and 2019. Clinical and anthropometric data were retrieved from medical records. Anthropometric assessment was done by using WHO standard growth curves. Data analysis was done using Statistical Package for Social Sciences V22. Statistical significance was set at p-value <0.05, and multivariable logistic regression was used to determine predictors.ResultsThere were 2400 pediatric admissions during the study period, CHD accounted for 6.5%(156) of admissions. For review, 141 records were eligible. The gender distribution was comparable, males 51.1% (72). Infants (<12 months) and older children (≥12 months) accounted for 57.4% (81) and 42.6% (60) of study subjects, respectively. SAM was documented in 51.8% (73) of the study subjects, [95% CI: 44.7–60.2]. Infants had higher odds of SAM compared to children aged ≥12 months[adjusted odds ratio (AOR)= 4.48, 95%CI:2.07–9.70]. Anemic children had higher odds for SAM[AOR =3.76, 95% CI:1.54–9.18]. Children without acyanotic CHD with heart failure(HF) were 58% less likely to develop SAM[AOR= 0.42, 95% CI:0.19–0.96].ConclusionThe burden of SAM among children with CHD is high. Younger age, anemia and acyanotic CHD with HF predicted SAM. Screening for anemia and targeted anthropometric assessment are recommended for early SAM detection.     

Assessing and understanding quality of care in a labour ward: A pilot study combining clinical and social science perspectives in Gondar,Ethiopia

Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources.     

Conventional cytogenetics in myelofibrosis: literature review and discussion

The clinical phenotype of myelofibrosis (MF) is recognized either de novo (primary) or in the setting of polycythemia vera (post-PV) or essential thrombocythemia (post-ET). Approximately one-third of patients with primary MF (PMF) present with cytogenetic abnormalities; the most frequent are del(20q), del(13q), trisomy 8 and 9, and abnormalities of chromosome 1 including duplication 1q. Other less frequent lesions include −7/del(7q), del(5q), del(12p), +21 and der(6)t(1;6)(q21;p21.3). In general, cytogenetic abnormalities are qualitatively similar among PMF, post-ET MF and post-PV MF although their individual frequencies may differ. Based on prognostic effect, cytogenetic findings in MF are classified as either ‘favorable’ or ‘unfavorable’. The former include normal karyotype or isolated del(20q) or del(13q) and the latter all other abnormalities. Unfavorable cytogenetic profile in both PMF and post-PV/ET MF confers an independent adverse effect on survival; it is also associated with higher JAK2V617F mutational frequency. In addition to their prognostic value, cytogenetic studies in MF ensure diagnostic exclusion of other myeloid neoplasms that are sometimes associated with bone marrow fibrosis (e.g. BCR-ABL1-positive or PDGFRB-rearranged) and also assist in specific treatment selection (e.g. lenalidomide therapy is active in MF associated with del(5q).     

Maternal rubella-specific antibody prevalence in Ethiopian infants

In countries with a high transmission rate of rubella the optimal age for universal rubella vaccination of infants is critically dependent upon the rate of loss of maternal antibodies. Few studies have investigated the decay characteristics of such antibodies. Mother:infant pairs were recruited at the Ethio-Swedish Children's Hospital, Addis Ababa, in 1994/95. Rubella antibody levels, determined by radial haemolysis, were available for analysis from 1542 infants aged 0-12 months, with 942 repeat measures, and from 846 mothers. Decay in seropositivity was well described by a delayed exponential function. The proportion seropositive at age 6, 9, or 12 months was 6-13%, 1-4%, or 0-1%, respectively, dependent upon assay cutoff level. Only infant age and mother's antibody level were important predictors of seropositivity. Results suggest that the success of vaccination at age 9 months or above would be little affected by residual maternal antibodies.     

Screening of some medicinal plants of Ethiopia for their anti-microbial properties and chemical profiles

In the indigenous health care delivery system of Ethiopia, numerous plant species are used to treat diseases of infectious origin. Regardless of the number of species, if any of such claims could be verified scientifically, the potential significance for the improvement of the health care services would be substantial. The objective of this study was, therefore, to determine the presence of anti-microbial activity in the crude extracts of some of the commonly used medicinal plants as well as to identify the class of compounds in the plants that were subjected to such screening. Thus, the crude methanol, petroleum ether and aqueous extracts of 67 plant species were subjected to preliminary screening against 10 strains of bacterial species and 6 fungal strains using the agar dilution method. A sample concentration of 250-2000 microg/ml and 500-4000 microg/ml were used for the bacterial and fungal pathogens, respectively. The results indicated that 44 different plant species exhibited activity against one or more of the bacteria while one species, viz., Albizzia gummifera showed activity against all the 10 bacteria at different gradient of dilution. Twenty three species inhibited or retarded growth of one or more organisms at dilution as low as 250 microg/ml. Extracts of same plants species were also tested against six different fungal pathogenic agents of which eight species showed growth inhibition against one or more of the organisms. Trichila emetica and Dovyalis abyssinica, which inhibited growth of four and five fungal strains at 100 microg/ml concentration, respectively, were the most promising plants. Chemical screening conducted on the extracts of all the plants showed the presence of several secondary metabolites, mainly, polyphenols, alkaloids, tannins sterols/terpenes, saponins and glycosides. The plants containing more of these metabolites demonstrated stronger anti-microbial properties stressing the need for further investigations using fractionated extracts and purified chemical components.     

An in-vivo study of falciparum malaria sensitivity to Chloroquine in unstable malaria endemic area of central Ethiopia

The role of Chloroquine as a first line drug to treat P. falciparum is almost universally becoming questionable. This study was conducted in one of the country's unstable malaria endemic area, North Shoa with the objective of assessing the in-vivo treatment efficacy of Chloroquine to falciparum malaria using the standard WHO 14 days treatment response monitoring guideline. A total of 427 patients were followed among which 87.8% showed treatment failure. This was more pronounced in children than in adults (Chi-square for trend = 8.16; P < 0.01). Clinical presentation with high grade fever on day 0 was found to be more predictive of treatment failure in children (OR = 2.06; 95% CI = 1.26, 3.36; P < 0.005). Tendency to remain febrile on subsequent follow up days was also more observed in children compared to adults. Treatment failure was further associated with high Parasite Density Index (PDI) on day 0 in all age groups (OR = 1.99; 95% CI = 1.04, 3.83; P < 0.05). Supplemented with large scale sensitivity studies, it is high time that switch to alternate drugs needs due consideration by policy makers.     

Sequential assignments of polymers by 2D NMR techniques: application to stereochemical configuration assignment of poly(acrylic acid)

Two-dimensional heteronuclear single quantum coherence — total correlation spectroscopy (2D HSQC-TOCSY) was used to make end-to-end sequential assignments and determine stereochemical configuration at the triad, tetrad and pentad levels of poly(acrylic acid). The pseudo three-dimensional experiment allows heteronuclear (¹³C-¹H) as well as homonuclear (¹H-¹H) corelations in a single 2D NMR experiment. The stereochemical configuration assignment is based on sequential identification of neighboring species. For example, a mmr tetrad resonance (methylene-¹³C) is determined by its correlations to the mm and mr triad resonances (methine) that constitute it. Hence, it is independent of chemical shift and peak intensity estimates that are requisites of the conventional method. This self-consistent technique enables absolute assignments of all magnetically unique tetrads and some of the pentad resonances. In addition, some resonances in the methylene and methine regions that have been difficult to characterize by conventional techniques were unequivocally assigned to endgroup resonances and other polymerization by-products of the low-molecular-weight poly(acrylic acid).