Effect of a community intervention with pit latrines in five districts of Amhara,Ethiopia

Objective To evaluate the change in household latrine coverage and investigated predictors of latrine uptake after 3 years of implementation of trachoma control interventions in Dera, Ebinat, Estie, Enebsie Sarmedir and Huleteju Enese districts of Amhara, Ethiopia. Methods Before and after study, baseline surveys were conducted prior to programme implementation and an evaluation after 3 years of interventions. Multi‐stage cluster random sampling was used in both surveys. Results A total of 1096 and 1117 households were sampled and assessed for the presence of household latrines at baseline and evaluation, respectively. The proportion of households with a pit latrine increased by 32.3% overall (95% confidence interval [CI]: 27.9–38.0), ranging from 8.0% (95% CI: 5.1–10.8) in Ebinat to 58.9% (95% CI: 51.9–66.8) in Enebsie Sarmedir. Logistic regression analysis of associations between household latrine ownership and potential factors showed that increasing household size (OR_{per additional person} = 1.2[95% CI: 1.1–1.3]), higher socio‐economic status (tin roof) (OR = 1.8[95% CI: 1.2–2.9]) and participation in health education (OR = 1.6[95% CI: 1.1–2.5]) were independent predictors of latrine ownership. Conclusion Our study documented heterogeneous increase in household latrine coverage after 3 years of latrine promotion; two of five districts had achieved millennium development goal 7.9 and halved the proportion of households without latrine access. We attribute the striking increase in household latrines to increased political commitment of the local government and intensive community mobilisation under the trachoma control programme in Amhara region.     

Distribution of Lymphocyte Subsets in Healthy Human Immunodeficiency Virus-Negative Adult Ethiopians from Two Geographic Locales

Immunological values for 562 factory workers from Wonji, Ethiopia, a sugar estate 114 km southeast of the capital city, Addis Ababa, Ethiopia, were compared to values for 218 subjects from Akaki, Ethiopia, a suburb of Addis Ababa, for whom partial data were previously published. The following markers were measured: lymphocytes, T cells, B cells, NK cells, CD4⁺ T cells, and CD8⁺ T cells. A more in depth comparison was also made between Akaki and Wonji subjects. For this purpose, various differentiation and activation marker (CD45RA, CD27, HLA-DR, and CD38) expressions on CD4⁺ and CD8⁺ T cells were studied in 60 male, human immunodeficiency virus-negative subjects (30 from each site). Data were also compared with Dutch blood donor control values. The results confirmed that Ethiopians have significantly decreased CD4⁺ T-cell counts and highly activated immune status, independent of the geographic locale studied. They also showed that male subjects from Akaki have significantly higher CD8⁺ T-cell counts, resulting in a proportional increase in each of the CD8⁺ T-cell compartments studied: naïve (CD45RA⁺CD27⁺), memory (CD45RA⁻CD27⁺), cytotoxic effector (CD45RA⁺CD27⁻), memory/effector (CD45RA⁻CD27⁻), activated (HLA-DR⁺CD38⁺), and resting (HLA-DR⁻CD38⁻). No expansion of a specific functional subset was observed. Endemic infection or higher immune activation is thus not a likely cause of the higher CD8 counts in the Akaki subjects. The data confirm and extend earlier observations and suggest that, although most lymphocyte subsets are comparable between the two geographical locales, there are also differences. Thus, care should be taken in extrapolating immunological reference values from one population group to another.     

Motivation and Factors Affecting It among Health Professionals in the Public Hospitals,Central Ethiopia

Background

Motivation is an individual''s degree of willingness to exert and maintain an effort towards organizational goals. This study assessed motivational status and factors affecting it among health professionals in public hospitals of West Shoa Zone, Oromia Region.

Method

Facility based cross-sectional survey was employed. All health professionals who served at least for 6 months in Ambo, Gedo and Gindeberet hospitals were included. Self-administered Likert scale type questionnaire was used. Data were analyzed using SPSS version 20. Mean motivation calculated as percentage of maximum scale score was used. Bivariate and multiple linear regression analyses were done to see the independent effects of explanatory variables.

Results

The overall motivation level of health professionals was 63.63%. Motivation level of health professionals varied among the hospitals. Gindeberet Hospital had lower motivation score as compared to Ambo Hospital (B = −0.54 and 95% CI; −0.08,−0.27). The mean motivation score of health professionals who got monthly financial benefit was significantly higher than those who did not (B = 0.71 and 95% CI; 0.32, 1.10). Environmental factors had higher impact on doctors'' motivation compared to nurses'' (B = 0.51 and 95% CI; 0.10, 0.92). Supervisor-related factors highly varied in motivation relative to other variables.

Conclusions

Motivation of health professionals was affected by factors related to supervisor, financial benefits, job content and hospital location. Efforts should be made to provide financial benefits to health professionals as appropriate especially, to those who did not get any such benefits. Officially recognizing best performance is also suggested.     

Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis

The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n?=?1753) and OCT-guidance versus IVUS-guidance (n?=?1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p?=?0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p?=?0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p?=?0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p?=?0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p?=?0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p?=?0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p?=?0.47), MI (OR 0.56 [0.12, 2.70] p?=?0.47), ST (OR 0.43 [0.06, 2.95] p?=?0.39), and TLR(OR 0.99 [0.45, 2.18] p?=?0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.     

Anthracyclines during induction therapy in acute myeloid leukaemia: a systematic review and meta‐analysis

This systematic review and meta‐analysis compared the efficacy of different anthracyclines and anthracycline dosing schedules for induction therapy in acute myeloid leukaemia in children and adults younger than 60 years of age. Twenty‐nine randomized controlled trials were eligible for inclusion in the review. Idarubicin (IDA), in comparison to daunorubicin (DNR), reduced remission failure rates (risk ratio (RR) 0·81; 95% confidence interval (CI), 0·66–0·99; P = 0·04), but did not alter rates of early death or overall mortality. Superiority of IDA for remission induction was limited to studies with a DNR/IDA dose ratio <5 (ratio <5: RR 0·65; 95% CI, 0·51–0·81; P < 0·001; ratio ≥5: RR 1·03; 95% CI, 0·91–1·16; P = 0·63). Higher‐dose DNR, compared to lower‐dose DNR, was associated with reduced rates for remission failure (RR 0·75; 95% CI, 0·60–0·94; P = 0·003) and overall mortality (RR 0·83; 95% CI, 0·75–0·93; P < 0·001), but not for early death. Comparisons of several other anthracycline derivates did not reveal significant differences in outcomes. Survival estimates in adults suggest that both high‐dose DNR (90 mg/m² daily × 3 or 50 mg/m² daily × 5) and IDA (12 mg/m² daily × 3) can achieve 5‐year survival rates of between 40 and 50 percent.     

High gestational weight gain and the risk of preterm birth and low birth weight: a systematic review and meta-analysis

ObjectiveMany women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births.Data SourcesWe searched Medline and Embase and reference lists.Study SelectionTwo assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams).Data extraction and synthesisThirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90).ConclusionAlthough women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.     

Characterization of peripheral blood lymphocyte subsets in patients with acute Plasmodium falciparum and P. vivax malaria infections at Wonji Sugar Estate, Ethiopia

We investigated the absolute counts of CD4+, CD8+, B, NK, and CD3+ cells and total lymphocytes in patients with acute Plasmodium falciparum and Plasmodium vivax malaria. Three-color flow cytometry was used for enumerating the immune cells. After slide smears were stained with 3% Giemsa stain, parasite species were detected using light microscopy. Data were analyzed using STATA and SPSS software. A total of 204 adults of both sexes (age, >15 years) were included in the study. One hundred fifty-eight were acute malaria patients, of whom 79 (50%) were infected with P. falciparum, 76 (48.1%) were infected with P. vivax, and 3 (1.9%) were infected with both malaria parasites. The remaining 46 subjects were healthy controls. The leukocyte count in P. falciparum patients was lower than that in controls (P=0.015). Absolute counts of CD4+, CD8+, B, and CD3+ cells and total lymphocytes were decreased very significantly during both P. falciparum (P<0.0001) and P. vivax (P<0.0001) infections. However, the NK cell count was an exception in that it was not affected by either P. falciparum or P. vivax malaria. No difference was found in the percentages of CD4, CD8, and CD3 cells in P. falciparum or P. vivax patients compared to controls. In summary, acute malaria infection causes a depletion of lymphocyte populations in the peripheral blood. Thus, special steps should be taken in dealing with malaria patients, including enumeration of peripheral lymphocyte cells for diagnostic purposes and research on peripheral blood to evaluate the immune status of patients.     

Decline in prevalence of HIV-1 infection and syphilis among young women attending antenatal care clinics in Addis Ababa,Ethiopia: results from sentinel surveillance, 1995-2001

From 1995 to 2001, five rounds of sentinel surveillance were carried out for young women attending antenatal care clinics at four health centers in Addis Ababa, the capital city of Ethiopia, to monitor trends in the prevalence of HIV infection and syphilis. Serum samples were tested for antibodies to HIV (enzyme-linked immunosorbent assay and Western blotting) and antibodies to Treponema pallidum (T. pallidum hemagglutination assay and rapid plasma reagin test). Prevalence ratios for an increase in one calendar year were estimated using log-binomial models. Between 1995 and 2001, the prevalence of HIV infection among young women (age range, 15-24 years) attending antenatal care clinics in inner city health centers declined from 24.2% to 15.1% (prevalence ratio for an increase in one calendar year, 0.91; 95% confidence interval, 0.87-0.95). No change was observed for older age groups or in outer city health centers. The decline in the prevalence of active syphilis (T. pallidum hemagglutination assay and rapid plasma reagin testing positive for antibodies to T. pallidum) was more pronounced among and also restricted to the young age groups (age range, 15-24 years) in the inner city (from 7.6% in 1995 to 1.3% in 2001; prevalence ratio, 0.69; 95% confidence interval, 0.59-0.80). The declining trends in the prevalence of HIV infection and syphilis among young women attending antenatal care clinics in the inner city are encouraging, but these findings require confirmation in future years and for other population groups.