Seasonal and altitudinal variations in fly density and their association with the occurrence of trachoma, in the Gurage zone of central Ethiopia

In the Gurage zone of central Ethiopia, the association between fly density and the occurrence of trachoma has been investigated across varying altitudes. The seasonal pattern of fly density in the area was also explored. When, over short sampling periods (10 min/child indoors and 10 min/child outdoors), hand nets were used to collect flies from the eyes of children aged 2-8 years, only Musca sorbens and M. domestica were caught. Almost all of the 13,147 'eye-seeking' flies collected came from villages at low (<2000 m; 40.7%) or mid altitudes (2200-2500 m; 58.6%) with only 0.7% of them caught in the high-altitude villages investigated (at >3000 m). Musca sorbens predominated outdoors and M. domestica indoors. Almost all (99.3%) of the eye-seeking M. sorbens collected were caught outdoors whereas most (76.7%) of the M. domestica were caught indoors (P<0.0001 for each). The median numbers of flies caught, per child, per 10-min collection, in the low-, mid- and high-altitude villages were 9.5, six and zero, respectively, for M. sorbens, and eight, three and zero, respectively, for M. domestica. The altitudinal trends in these numbers of 'eye-seeking' flies matched those in the prevalences of active trachoma among children aged 1-10 years, which were high in the villages at low (81.6%) and mid altitude (78.7%) but much lower (1.7%) in the high-altitude villages. In conclusion, trachoma is a common disease of public-health importance only in the low- and mid-altitude villages in the Gurage zone, where there are large numbers of eye-seeking flies, and not in the villages that lie >3000 m above sea level, where there is a dearth of such flies.     

Illness Representation and Associated Factors among Hypertensive Patients in Central Ethiopia

BackgroundIllness representation is an implicit belief system about an illness constructed by an individual to give meaning to their illness. An individual''s belief about his/her illness, treatment, and own control are known to influence an individual''s ability to cope with the illness and sustain the health-related quality of life. However, how Ethiopians perceive hypertension has not been studied well. This study aimed to assess illness representation and associated factors among hypertensive patients in Central Ethiopia.MethodA facility-based cross-sectional study was conducted in four public hospitals in Central Ethiopia. A total of 989 patients participated in the study. The revised Illness Representation Questionnaire was used to collect relevant data. Data were analyzed using the Generalized Estimating Equation with an ordinal logistic regression model and exchangeable working correlation matrix. A P-Value of less than 0.05 was indicated statistical significance.ResultsOverall, 64.3% (95% CI: 61.3, 67.4) of the respondents reported low to moderate Illness representation about their hypertension. Respondents who were housewife [AOR: 1.48, 95% CI= 1.05, 2.08], in older age category 50–64 years [AOR: 1.92, 95% CI= 1.19, 3.09] and ≥ 65 years [AOR: 2.38, 95% CI= 1.43, 3.96], and had no family support [AOR: 1.98, 95% CI= 1.44, 2.73] showed a significant association with Illness Representation.ConclusionThis study revealed that about two-thirds of hypertensive patients in Central Ethiopia perceived hypertension as a low to moderately threatening illness. Such low illness representation undermines initiation of treatment and effective control of blood pressure. Health care providers need to strengthen strategies that increase their patient''s illness representation.     

Aflatoxin contamination of human breast milk and complementary foods in southern Ethiopia

Exposure to unsafe level of aflatoxin in early life may lead to growth faltering. However, the extent of contamination of breast milk and complementary foods is poorly examined. We determined aflatoxin M₁ (AFM₁) and B₁ (AFB₁) contamination of human breast milk and cereal‐based cooked complementary foods, respectively, among households having children 6–23 months of age in Sidama zone, southern Ethiopia. Data were collected through two cross‐sectional surveys implemented in the wet (n = 180) and dry (n = 180) seasons. Eligible households (n = 360) were recruited from three agroecological zones (lowland, midland and highland, each with sample size of 120) using a multistage sampling technique. AFB₁ and AFM₁ levels were determined using enzyme‐linked immunosorbent assay. Mann–Whitney U and Kruskal–Wallis tests were performed to compare aflatoxin levels between seasons and across the agroecological zones. Among 360 breast milk samples tested, 64.4% had detectable AFM₁ and 5.3% exceeded the 0.025 parts per billion (ppb) limit set by the European Union for infant milk. The median AFM₁ in the lowlands was significantly higher than in the other agroecological settings (P < 0.001). By season, AFM₁ was higher in breast milk samples collected in the dry season (P = 0.041). AFB₁ was detected in 96.4% of the food samples tested, and 95.0% had concentration exceeding the permissible European Union limit of 0.1 ppb. The median AFB₁ was significantly higher in the lowland (P = 0.002), but there was no difference between the seasons (P = 0.386). The study indicated that, in southern Ethiopia, foods intended for infants are heavily contaminated with AFB₁. Contamination of breast milk is also a significant health concern.     

Multi-institutional experience with penetrating pancreatic injuries in children

Purpose

Penetrating pancreatic injuries in children are uncommon and are not well described in the literature. We report a multi-institutional experience with penetrating pancreatic injuries in children.

Methods

A retrospective review of children sustaining penetrating pancreatic injuries was performed at eight pediatric trauma centers.

Results

Sixteen patients were identified. Eleven patients were male; (mean ± SE) age was 11.7 ± 1.2 years. The mechanism of injury was gun-shot wound in 14 patients and mean injury-severity score was 18 ± 3. All patients had associated injuries, most frequently small bowel injuries (n = 9). Patients had either grade I (n = 4), grade II (n = 7), or grade III (n = 4) injuries; there was a single grade V injury. All patients underwent exploratory celiotomy. Drainage of the injured pancreas was performed in 11 patients, and 2 patients underwent pancreatorrhaphy in addition to drainage; 3 underwent resection for grade III (n = 2) and grade V (n = 1) injuries. Thirteen patients required other intra-abdominal procedures. All patients required intensive care over a mean 11.0 ± 3.0 days. Mean duration of stay was 30.1 ± 5.6 days. Post-operative morbidity was 62.5 % with no mortalities.

Conclusions

Penetrating pancreatic injuries in children are uncommon and most often due to firearms. There is a high association with other injuries particularly hollow viscous perforation.     

Sero-prevalence of Hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone,Southwest Ethiopia: Community based cross-sectional study

BackgroundHepatitis B virus infection is one of the leading causes of liver diseases which occurs worldwide particularly in developing countries. It is often caused by prenatal transmission from mother to child or household transmission from a close contact during early childhood. It causes different complications like; jaundice, induces premature labor, and prematurity.ObjectiveThe aim of this study was to estimate the sero-prevalence of hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, South West Ethiopia.MethodsA community-based cross-sectional study was conducted from December 15th, 2016 to February 15th, 2017. Multistage sampling technique was applied to select study participants. Logistic regression analysis was applied and p-values < 0.05 was used to see the significant association between dependent and independent variables.ResultsA total of 330 participants were included in this study yielding 98.8% response rate. The sero-prevalence of hbsag among women of reproductive age was 28(8.5%). Having multiple sexual partners (AOR = 18.73, 95% CI = [3.65, 96.21) history of unprotected sex (AOR = 9.39, 95% CI = [1.64, 53.77) were found to be significantly associated with sero-prevalence of HBV.ConclusionsThe sero-prevalence of HBV infection among women of reproductive age was highly endemic. Hence, behavioral education and communication programs focusing on reduction of risky sexual behaviors should be designed to reduce HBV infection.     

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%–46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%–77%). Women involved in home gardening significantly increased (73%–93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.     

The effects of recruitment of renal functional reserve on renal cortical and medullary oxygenation in non-anesthetized sheep

Aim

Recruitment of renal functional reserve (RFR) with amino acid loading increases renal blood flow and glomerular filtration rate. However, its effects on renal cortical and medullary oxygenation have not been determined. Accordingly, we tested the effects of recruitment of RFR on renal cortical and medullary oxygenation in non-anesthetized sheep.

Methods

Under general anesthesia, we instrumented 10 sheep to enable subsequent continuous measurements of systemic and renal hemodynamics, renal oxygen delivery and consumption, and cortical and medullary tissue oxygen tension (PO₂). We then measured the effects of recruitment of RFR with an intravenous infusion of 500 ml of a clinically used amino acid solution (10% Synthamin® 17) in the non-anesthetized state.

Results

Compared with baseline, Synthamin® 17 infusion significantly increased renal oxygen delivery mean ± SD maximum increase: (from 0.79 ± 0.17 to 1.06 ± 0.16 ml/kg/min, p < 0.001), renal oxygen consumption (from 0.08 ± 0.01 to 0.15 ± 0.02 ml/kg/min, p < 0.001), and glomerular filtration rate (+45.2 ± 2.7%, p < 0.001). Renal cortical tissue PO₂ increased by a maximum of 26.4 ± 1.1% (p = 0.001) and medullary tissue PO₂ increased by a maximum of 23.9 ± 2.8% (p = 0. 001).

Conclusions

In non-anesthetized healthy sheep, recruitment of RFR improved renal cortical and medullary oxygenation. These observations might have implications for the use of recruitment of RFR for diagnostic and therapeutic purposes.     

Understanding factors associated with rural-urban disparities of stunting among under-five children in Rwanda: A decomposition analysis approach

Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under-5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015 and 2020, we employed the Blinder-Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal education and the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country. There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high-burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting.