Leech Infestation: The Unusual Cause of Upper Airway Obstruction

This paper presents a case of a 7 year-old child who presented with a 14-days history of blood stained saliva and shortness of breath of 3 days with signs of upper airway obstruction. Laryngoscopy revealed a blackish living foreign body in the proximal trachea. Under general anesthesia the leech was removed by applying forceps. I conclude that a high index of suspicion of leech infestation is required when faced with a child presenting with unexplained bleeding per mouth and signs of upper airway obstruction.     

Evaluation of a community intervention for promotion of safe motherhood in Eritrea

Introduction: We evaluated a community‐based intervention to promote safe motherhood, focusing on knowledge and behaviors that may reduce maternal mortality and birth complications. The intervention aimed to increase women's birth preparedness, knowledge of birth danger signs, use of antenatal care services, and birth at a health care facility. Methods: Volunteers from a remote rural community in Northern Eritrea were trained to lead participatory educational sessions on safe motherhood with women and men. The evaluation used a quasiexperimental design (nonequivalent group pretest‐posttest) including cross‐sectional surveys with postpartum women (pretest n = 466, posttest n = 378) in the intervention area and in a similar remote rural comparison area. Results: Women's knowledge of birth danger signs increased significantly in the intervention area but not in the comparison area. There was a significant increase in the proportion of women who had the recommended 4 or more antenatal care visits during pregnancy in the intervention area (from 18% to 80%, P < .001), although this proportion did not change significantly in the comparison area (from 53% to 47%, P= .194). There was a greater increase in birth in a health care facility in the intervention area. Discussion: Participatory sessions led by community volunteers can increase safe motherhood knowledge and encourage use of essential maternity services.     

Low incidence of syphilis among factory workers in Ethiopia: effect of an intervention based on education and counselling

BACKGROUND: The prevalence and incidence of syphilis infection were examined in a cohort study of factory workers in Ethiopia. METHOD: Between February 1997 and March 1999, 409 men and 348 women were enrolled and followed in the cohort study. RESULTS: The prevalence (95% CI) of past/current syphilis (positive TPPA serology) was 28.9% (25.7% to 32.3%), and factors associated with past/current syphilis were markers of risky sexual behaviours including HIV infection. In this cohort of factory workers subject to public information/education meetings, testing for HIV antibodies, and individual counselling, the incidence (97.5% one sided CI) of new syphilis infections was 0/691 = 0 (0 to 0.5) per 100 person years. CONCLUSION: This study has documented a reduction in risky sexual behaviours and a low syphilis incidence among factory workers participating in a cohort study on HIV infection progression in Addis Ababa.     

Smear Posetive Pulmonary Tuberculosis (PTB) Prevalence Amongst Patients at Agaro Teaching Health Center,South West Ethiopia

Background

World Health organization (WHO) declared tuberculosis as a global emergency because it poses a serious public health threat in different countries especially, in Africa. According to WHO report of 2007, Directly Observed Treatment Short course (DOTS) coverage in Ethiopia reached 95 percent of the population; despite this fact the trend of tuberculosis in most of the districts of Ethiopia is not known. Hence, this study has revealed the trend and determined the overall prevalence of smear positive pulmonary tuberculosis in five years (2005/6–2009/10) in Agaro teaching health center, south west Ethiopia.

Methods

A retrospective study based on record review was conducted at Agaro Teaching Health center on sputum examination record of patient''s from 2005/6–2009/10(five years). Socio demographic data and sputum laboratory results were collected using pre-designed questionnaire and the data was entered into a computer using SPSS version 16 for windows. Finally, cross tab analysis and Chi-square was calculated at P-value less than 0.05 to check possible association between socio-demographic variables and smear positivity.

Results

The overall five years prevalence of smear positive pulmonary tuberculosis was found out to be 10.9%. On the other hand, the percentage of smear positive pulmonary tuberculosis cases showed gradual decrease from 19.5% in 2005/6 to 5.8% cases in 2009/10.

Conclusion

Tuberculosis is still the major problem of Agaro health center catchment area even though there is a decrease in trend from year to year. Hence, the respective health bureau and other stake holders should still need to strengthen their effort to control it.     

Surveillance of Bacterial Meningitis,Ethiopia, 2012–2013

Among 139 patients with suspected bacterial meningitis in Ethiopia, 2012–2013, meningococci (19.4%) and pneumococci (12.9%) were the major disease-causing organisms. Meningococcal serogroups detected were A (n = 11), W (n = 7), C (n = 1), and X (n = 1). Affordable, multivalent meningitis vaccines for the African meningitis belt are urgently needed.     

Presumptive treatment to reduce imported malaria among refugees from east Africa resettling in the United States

During May 4, 2007-February 29, 2008, the United States resettled 6,159 refugees from Tanzania. Refugees received pre-departure antimalarial treatment with sulfadoxine-pyrimethamine (SP), partially supervised (three/six doses) artemether-lumefantrine (AL), or fully supervised AL. Thirty-nine malaria cases were detected. Disease incidence was 15.5/1,000 in the SP group and 3.2/1,000 in the partially supervised AL group (relative change = -79%, 95% confidence interval = -56% to -90%). Incidence was 1.3/1,000 refugees in the fully supervised AL group (relative change = -92% compared with SP group; 95% confidence interval = -66% to -98%). Among 39 cases, 28 (72%) were in refugees < 15 years of age. Time between arrival and symptom onset (median = 14 days, range = 3-46 days) did not differ by group. Thirty-two (82%) persons were hospitalized, 4 (10%) had severe manifestations, and 9 (27%) had parasitemias > 5% (range = < 0.1-18%). Pre-departure presumptive treatment with an effective drug is associated with decreased disease among refugees.     

Synthesis and Antiplasmodial and Antimycobacterial Evaluation of New Nitroimidazole and Nitroimidazooxazine Derivatives

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Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial

We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2–59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9–25.7%) and comparison (23.3–29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia''s iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services.     

Comparison of immune responses to a killed bivalent whole cell oral cholera vaccine between endemic and less endemic settings

Studies on safety, immunogenicity and efficacy of the killed, bivalent whole cell oral cholera vaccine (Shanchol) have been conducted in historically endemic settings of Asia. Recent cholera vaccination campaigns in Haiti and Guinea have also demonstrated favourable immunogenicity and effectiveness in nonendemic outbreak settings. We performed a secondary analysis, comparing immune responses of Shanchol from two randomised controlled trials performed in an endemic and a less endemic area (Addis Ababa) during a nonoutbreak setting. While Shanchol may offer some degree of immediate protection in primed populations living in cholera endemic areas, as well as being highly immunogenic in less endemic settings, understanding the characteristics of immune responses in each of these areas is vital in determining ideal dosing strategies that offer the greatest public health impact to populations from areas with varying degrees of cholera endemicity.     

Seroprevalence of human immunodeficiency virus among blood donors in Northwest Ethiopia, 1995-2002

Data on age, sex, occupation, HIV serostatus and year of donation were collected from the blood donors log book of Gondar College of Medical Sciences Hospital, Northwest Ethiopia, for the period between January 1995 and December 2002 and analysed. The crude HIV seroprevalence was 9.9% (1109/11,204). A declining trend in the prevalence was observed from as high as 15.7% (207/1321) in 1995 to 9.3% (123/1327) in 1999 and down to 4.3% (68/1576) in 2002. The declining trend observed in recent years is encouraging and should further be strengthened by making use of the blood bank as an entry point for HIV testing and counselling services.