Severe malaria in the under-fives--clinical featrues, management and outcome in a district hospital

A prospective hospital based study on severe malaria in under-five children was carried out over a period of one year in a district hospital of Ethiopia to determine the case fatality rate (CFR), factors contributing for high mortality, health seeking behaviour of the care takers, direct cost and feasibility of operating the WHO treatment guidelines at a district level. One hundred and one children aged between 6 and 59 months fulfilling the criteria of severe malaria have been recruited in the study and treated according to WHO guidelines. The most frequently encountered clinical manifestations of severe malaria were prostration and hypoglycaemia, the prevalence being 28.7% respectively. The over all case fatality rate of severe malaria was 11.9%. Cerebral malaria was the only isolated form of severe malaria with high CFR (OR=5.06, 95%CI 1.01-25.1). The hospital CFR of severe anaemia was 16.7%, which could have been reduced by provision of safe blood transfusion. Most of the children (80.2%) presented to the hospital in more than 24 hours after the onset of the illness. Forty seven percent of children received drugs at home and in 96% of the cases it was antimalarial drugs. The antimalarial drug treatment (dose/duration) was adequate in 71%. Children receiving appropriate anti-malaria treatment at home show a tendency towards a lower CFR. The total direct cost per disease episode ranged from USD 13.75 to 27.5. Eighty five percent of the direct cost was due to expenditures in the hospital. Implementation of the management protocol based on the WHO guidelines has required substantial input of resources. Major constraints noted were related to availability of safe blood andfollow-up after discharge. The study provides useful information for improved case management of severe malaria thereby reduce mortality of the under-five children due to severe malaria.     

Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: a community-based study

Background  

Health care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors. In Ethiopia, there are limited studies regarding the health seeking behaviour of tuberculosis (TB) suspects and TB patients. However, a thorough understanding of patients' motivation and actions is crucial to understanding TB and the treatment of disease. Such insights would conceivably help to reduce delay in diagnosis, improve treatment adherence and thereby reduce transmission of TB in the community. The objective of this study was to describe and analyze health care seeking among TB suspects and pulmonary TB (PTB) cases in a rural district of the Amhara Region in Ethiopia.     

Daratumumab,bortezomib, cyclophosphamide and dexamethasone in newly diagnosed and relapsed multiple myeloma: LYRA study

This United States community study evaluated the combination of daratumumab, bortezomib, cyclophosphamide and dexamethasone (D-VCd) in newly diagnosed multiple myeloma (NDMM) and relapsed multiple myeloma (RMM). Patients received 4–8 induction cycles of bortezomib 1·5 mg/m², cyclophosphamide 300 mg/m² and dexamethasone 40 mg weekly. Intravenous daratumumab 16 mg/kg was administered as approved except for a split-first dose in Cycle 1. Eligible patients underwent autologous stem cell transplantation. All patients received ≤12 daratumumab maintenance doses monthly. Eighty-six NDMM and 14 RMM patients received ≥1 treatment dose. In NDMM patients, very good partial response or better (≥VGPR) and overall response rates after 4 induction cycles were 44% (primary endpoint) and 79%, respectively, and 56% and 81% at end of induction. The 12-month progression-free survival (PFS) rate was 87%. Efficacy was also observed in RMM patients. Fatigue (59%) and neutropenia (13%) were the most frequent treatment-emergent adverse event (TEAE) and grade 3/4 TEAE, respectively. Infusion reactions occurred in 54% of patients, primarily during the first dose, and were mild (2% grade 3). The first 2 daratumumab infusions were 4·5 and 3·8 h (median). Overall, D-VCd was well tolerated, split-first daratumumab dosing was feasible, the ≥VGPR rate after 4 cycles was 44% and the 1-year PFS rate was 87%.     

Sero-prevalence of brucellosis in occupationally exposed people in Addis Ababa, Ethiopia

OBJECTIVE: Brucellosis is a Zoonosis, recognized worldwide as a serious public health hazard and economically significant disease. The etiologic agent of this disease is a bacterial species of the genus Brucella that causes undulant fever, sterility and other systemic illnesses in human. Thus, the aim of this study was to undertake seroepidemiological study of brucellosis on occupationally exposed persons in Addis Ababa abattoirs enterprise and different dairy farms. METHODS: Three hundred thirty six human individuals were screened using Rose Bengal Plate Test (RBPT) and the sera were further subjected to 2- Mercapto Ethanol Test (2-MET). Simultaneously, survey was conducted in farms and slaughterhouse to investigate epidemiological factors. RESULTS: An overall seroprevalence rate of 4.8% (16/336) was determined by taking RBPT+/2MET+ as confirmatory test (P < 0.05). Some of the risk factors contributing to the occurrence of the disease include occupation, gender, and unsafe handling of infected materials. Raw milk and meat consumption, lack of awareness and use of detergents were also found as important factors. CONCLUSION: The seroprevalence of brucellosis is expected to be more in other areas of the Region, where there is high human-animal contact and high number of cattle population with a respective traditional system of animal rearing.     

Endemic existence of rabies in Ethiopia

The study on the prevalence of rabies was conducted on a retrospective data gathered from EHNRI rabies diagnostic laboratory Addis Ababa, in the years 1979-1987. During this period a total of 8036 animals were brought to the rabies diagnostic laboratory. Ninety one percent (7329) of these animals were dogs. The remaining 8.8% (707) comprised of cats, domestic animals (donkeys, cows, sheep) and wild animals (monkeys, jackals and hyenas). Out of 7329 dogs examined 832 were positive for rabies. Dogs accounted for the majority of animal rabies (94.01% of the total positive animals). The remaining 5.99% (53) of the animals diagnosed with rabies-comprised of cats, domestic animals and some wild animals. A total of 15,940 people were given post exposure anti-rabies prophylaxis treatment that came from different parts of the country in the years 1979-1987. The prevalence rates of rabies were found to be higher soon after dogs' breeding seasons. Such an observation indicates that among dogs infection, transmission through biting is significant during the breeding season. However, despite the high incidence of rabies in Ethiopia, only 320 people were reported to have died of rabies in the years 1979-1984. This supports, the hypothesis that there is a lack of appropriate reporting system on prevalence of rabies and its impact on humans in Ethiopia.     

Spoligotyping of Mycobacterium tuberculosis isolates among pulmonary tuberculosis patients in Amhara Region,Ethiopia

The aim of this study was to characterize Mycobacterium tuberculosis isolates circulating in the Amhara Region of Ethiopia. Sputum samples were collected from new pulmonary tuberculosis (TB) patients in the Region. Genotyping of mycobacterial DNA was performed by spoligotyping and isolates were assigned to families using the SpolDB4 and the model‐based program ‘Spotclust’. A high level of diversity was found among the 237 isolates. Sixty‐five different spoligopatterns were obtained. The T (30.8%), Central Asian (CAS; 21.1%) and U (17.7%) families were the predominant isolates comprising 69.6% of the total strains. Eighty‐five per cent of the U lineage belonged to Spoligo‐International‐Type (SIT) 910 and SIT 1729. Only a few of these strains are included in SpolDB4 to date. Of the total strains, 41 (17.3%) were unique and have not been described in SpolDB4 to date. This study indicated that the TB epidemic in Amhara Region, Ethiopia, is characterized by the circulation of numerous M. tuberculosis strain families. The high proportion of SIT 910 and SIT 1729 strains may indicate an increase in the importance of these lineages in the transmission of TB in the study region.     

Compact TiO2 films with sandwiched Ag nanoparticles as electron-collecting layer in planar type perovskite solar cells: improvement in efficiency and stability

Fabrication of perovskite solar cells (PSCs) in a simple way with high efficiency and stability remains a challenge. In this study, silver nanoparticles (Ag NPs) were sandwiched between two compact TiO₂ layers through a facile process of spin-coating an ethanolic AgNO₃ solution, followed by thermal annealing. The presence of Ag NPs in the electron-transporting layer of TiO₂ improved the light input to the device, the morphology of the perovskite film prepared on top, and eliminated leakage current. Photoluminescence and electron mobility studies revealed that the incorporation of Ag NPs in the ETL of the planar PSC device facilitated the electron–hole separation and promoted charge extraction and transport from perovskite to ETL. Hysteresis-free devices with incorporated Ag NPs gave a high average short-circuit current density (J_sc) of 22.91 ± 0.39 mA cm⁻² and maximum power conversion efficiency of 17.25%. The devices also showed enhanced stability versus a control device without embedded Ag NPs. The possible reasons for the improvement are analyzed and discussed.

Embedding silver nanoparticles in the compact TiO₂ layer effectively improves the efficiency and stability of a perovskite solar cell.