International prostate symptom score as a clinical outcome measure for Ethiopian patients with urethral stricture

Eighty-four urethral stricture patients and 73 controls were studied prospectively over a 6 months period in Tikur Anbessa Hospital from April to August 2000. The purpose of the study was to evaluate the use of International Prostate Symptom Score (IPSS) as an outcome measurement instrument for urethral stricture patients in Ethiopia. The Amharic translation of IPSS (IPSS Amh) was used in this study. Internal consistency was 0.91. Construct validity was 0.73. Test-retest reliability was 0.95. Sensitivity and specificity were 76% and 71% respectively. In conclusion the IPSS Amh was found to be valid for use in urethral stricture patients in Ethiopia. We recommend the wide use of this cheap and easily available clinical measurement instrument.     

Clinical value of uroflowmentry in selected cases of bladder outlet obstruction

Fifteen patients with Benign Prostatic Hyperplasia (BPH), 42 urethral stricture patients, and 34 controls were included in this study to describe outflowmetry findings at Tikur Anbessa Hospital in Addis Abeba from April to August 2000. Normal values for maximum and average urine flow rates were determined Uroflowmetry findings in BPH and urethral stricture were compared with normal subjects. The average age for BPH, urethral stricture, and controls were 63.3 (SD +/- 10.3), 38.4 (SD +/- 12.4), and 28.5 (SD +/- 7.9) respectively. The mean maximum flow rates for normal subjects was 22.7 ml/sec (range 15 to 42 ml/sec) and mean average flow rates 14.7 ml/sec (range 9 to 25 ml/sec). Mean maximum flow rate for BPH and Urethral Stricture were 11.5 (SD +/- 8.2) and 8.7 (SD +/- 6.5) ml/sec respectively. For urethral stricture maximum flow rate had sensitivity and specificity of 91% and 85% respectively. For BPH sensitivity was 100% and specificity 80%. Normal values are set for the study population. Uroflowmetry has high sensitivity and specificity. It can widely be used in routine-evaluation of BPH and urethral stricture patients.     

Epidemiology of Infectious Keratoconjunctivitis in Cattle in South‐east Ethiopia

The aim of the study was to determine the prevalence of infectious keratoconjunctivitis on cross‐breed dairy farms and to evaluate factors that influence its distribution. A total of 11 dairy farms and one cattle cross‐breeding farm in different parts of Arsi region, south‐east Ethiopia were clinically and bacteriologically investigated from February 1989 to December 1990. Out of 5221 local zebu and cross‐breed dairy animals, 110 were found to have different degrees of infectious bovine keratoconjunctivitis. Of these, 94 (85.5 %) were unilateral and 16 (14.5 %) were bilateral. The prevalence of the disease was significantly (P < 0.001) influenced by age and breed; high exotic blood level and younger age groups were mainly affected. However, severity of the disease was not significantly associated with age (P > 0.750). Moraxella bovis was isolated from 88 (80 %) of the 110 bacteriologically positive cases. Of these isolates, 61 (69 %) were haemolytic and 27 (31 %) were non‐haemolytic strains. Infection with M. bovis was unilateral. Concurrent infections with M. bovis included Actinomyces pyogenes 23 (21 %), Staphylococcus aureus 17 (15 %), Pasteurella haemolytica nine (8 %), Escherichia coli eight (7 %) and Proteus spp. four (3.6 %).     

Comparison of an rRNA-based and DNA-based nucleic acid amplification test for the detection of Chlamydia trachomatis in trachoma

BACKGROUND/AIM: The World Health Organisation (WHO) hopes to achieve global elimination of trachoma, still the leading cause of preventable blindness worldwide, in part through mass antibiotic treatment. DNA-based nucleic acid amplification tests (NAATs) are currently used to evaluate the success of treatment programmes by measuring the prevalence of C trachomatis infection. Some believe that newer ribosomal RNA (rRNA)-based tests may be much more sensitive since bacterial rRNA is present in amounts up to 10 000 times that of genomic DNA. Others believe that rRNA-based tests are instead less sensitive but more specific, due to the presence of dead or subviable organisms that the test may not detect. This study compares an rRNA-based test to a DNA-based test for the detection of ocular C trachomatis infection in children living in trachoma-endemic villages. METHODS: An rRNA-based amplification test and DNA-based polymerase chain reaction (PCR) were performed on swab specimens taken from the right upper tarsal conjunctiva of 56 children aged 0-10 years living in two villages in Amhara, Ethiopia. RESULTS: The rRNA-based test detected ocular C trachomatis infection in 35 (63%) subjects compared with 22 (39%) detected by PCR (McNemar's test, p = 0.0002). The rRNA-based test gave positive results for all subjects that were positive by PCR, and also detected infection in 13 (23%) additional subjects. CONCLUSION: The rRNA-based test appears to have significantly greater sensitivity than PCR for the detection of ocular chlamydial infection in children in trachoma-endemic villages. Using the rRNA-based test, we may be able to detect infection that was previously missed with PCR. Past studies using DNA-based tests to assess prevalence of infectious trachoma following antibiotic treatment may have underestimated the true prevalence of infection.     

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia

Abstract Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.     

Latrine promotion for trachoma: assessment of mortality from a cluster-randomized trial in Ethiopia

Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion. At a follow-up census 26 months after the baseline treatment, 320 persons had died. The mortality rate of children 1-5 years of age was 3.87 (95% confidence interval [CI] = 2.19-6.82) per 1,000 person-years in the latrine promotion arm, and 2.72 (95% CI = 1.37-5.42) per 1,000 person-years in the control arm. In a multi-level mixed effects logistic regression model controlling for age, there was no difference in mortality in persons randomized into the latrine or control arms (odds ratio = 1.18, 95% CI = 0.89-1.58). Latrine promotion provided no additional effect on mortality in the context of an azithromycin distribution program (clinicaltrials.gov, #NCT00322972).