Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia

Objective To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART) in Jimma, Ethiopia. Methods Unmatched case control study: cases were individuals who had missed two or more clinical appointments (i.e. had not been seen for the last 2 months) between January 2005 and February 2007; controls were individuals who had been on ART at least for 1 year and were rated as excellent adherers by the providers. Data were collected from patient records, and by telephone call and home visit to identify the reason for defaulting. Results Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were loss of hope in medication, lack of food, mental illness, holy water, no money for transport, and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases. Taking hard drugs (cocaine, cannabis and IV drugs), excessive alcohol consumption, being bedridden, living outside Jimma town and having an HIV negative or unknown HIV status partner were associated with defaulting ART. Conclusion A significant proportion of patients defaulted from ART treatment. ART clinics should ensure that patients’ addresses are correct and complete. Programmatic and counseling efforts to decrease ART defaulting should address illicit drug and excessive alcohol use, decentralise ART services, institute home‐based treatment options for seriously ill and bedridden patients, and address patients concerns.     

Isolation and characterisation of Ralstonia solanacearum strains from Solanaceae crops in Ethiopia

Eighty one isolates of Ralstonia solanacearum -like bacteria on triphenyl tetrazolium chloride (TTC) medium were collected from different Solanaceae crops (i.e. potato, tomato and pepper plants and potato tubers) at various sites in Ethiopia. Of these, 62 strains were identified as R. solanacearum based on their cultural characteristics on TTC medium, tomato pathogenicity bioassay, carbon source utilisation patterns and a specific PCR-based assay. By Hayward's classification method, based on carbon source utilisation, 19 of the 62 R. solanacearum strains were identified as biovar I and 43 strains were identified as biovar II. The biovar I strains exhibited a high growth rate at high temperatures (37 degrees C). Whereas the growth rate of biovar II strains was greatest at lower temperatures (22 degrees C). Biovar I strains had broader host range than biovar II strains, which were limited to potato, tomato, and eggplant. To our knowledge, this is the first report of R. solanacearum biovar I in Ethiopia. The existence of biovar I strains in Ethiopia raises concerns because they have a broader host range than biovar II strains.     

Has oral fluid the potential to replace serum for the evaluation of population immunity levels? A study of measles,rubella and hepatitis B in rural Ethiopia.

OBJECTIVE: To assess the suitability of using oral-fluid samples for determining the prevalence of immunity to vaccine-preventable infections. METHODS: Paired blood and oral-fluid samples were obtained from 853 individuals of all ages from a rural Ethiopian community. Oral fluid around the gums was screened for measles- and rubella-specific antibodies using enhanced IgG antibody capture (GAC) enzyme-linked immunosorbent assays (ELISAs), and for anti-HBc antibodies using a prototype GACELISA. IgG antibodies in serum to measles, rubella and HBc were determined using commercial ELISAs. FINDINGS: Relative to serum, oral fluid assay sensitivity and specificity were as follows: 98% and 87% for measles, 79% and 90% for rubella, and 43% and 87% for anti-HBc. These assay characteristics yielded population prevalence estimates from oral fluid with a precision equal to that of serum for measles (all ages) and rubella (ages < 20 years). CONCLUSION: Our results suggest that oral fluid could have the potential to replace serum in IgG antibody prevalence surveys. Further progress requires assessment of variation in assay performance between populations as well as the availability of standardized, easy to use assays.     

A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females

Background  

Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated.     

Cost of hospitalization of diabetic patients admitted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

OBJECTIVE: In Ethiopia the problems passed by diabetes is increasing for the last two to three decades. This indicates that diabetes is becoming a major economic factor in drug use and bed occupancy. So far there has been no study conducted to evaluate the cost of care among Ethiopian diabetic patients. This study aimed at assessing the cost of hospitalization of diabetic patients. METHODS: A case control study was conducted on consecutive 146 diabetic patients and 142 non diabetic controls admitted to the medical wards of Tikur Anbessa Specialized Hospital. Every first non-diabetic patient who was admitted to the same ward on the same day or in the subsequent days was taken as a control group. RESULTS: The average total cost of hospitalization of cases was significantly higher than the controls with mean cost of 1109.7 +/- 1026.4 for cases and 872.9 +/- 828.3 Birr for controls respectively, (p < 0.03). A large proportion (57%) of the total cost was utilized for treatment of acute and chronic complications of diabetes. The average treatment and laboratory cost were significantly higher among cases compared to controls (p = 0.013 and p = < 0.001 respectively). However, when adjusted by age, sex, address and history of hypertension and renal diseases, the average cost of laboratory investigation remained significantly higher for cases. CONCLUSION: The current study demonstrated that the direct cost of hospitalization of diabetic patient is significantly higher than non diabetics. The study showed that substantial proportion of the total cost of admission is utilized for treating acute and long term complications. This study warrants further research, attention of the health policy makers and health providers for future planning of prevention, diagnosis and treatment of diabetes.     

Assessment of quality of post abortion care in government hospitals in Addis Ababa, Ethiopia

BACKGROUND: Unsafe abortion is the leading cause of maternal death in Ethiopia. It is also known to cause several acute and long-term complications leading to disabilities. In countries like Ethiopia where there is no access to safe abortion, improvement of the available postabortion care services is an important strategy. OBJECTIVES: The aim of the study is to assess the quality of health services with respect to postabortion care in hospitals in Addis Ababa, Ethiopia. METHODS: A cross sectional survey on quality of postabortion care was conducted among 422 postabortion patients attending four hospitals in Addis Ababa. Additionally, 42 service providers involved in providing postabortion care services were interviewed. Direct service delivery observation and inventory of equipment and supplies were also conducted. The data were analyzed using Statistical Package for Social Sciences. RESULTS: Interaction between service providers and patients was found to be satisfactory whereas information provision on important aspects of care such as danger signs and follow-up needs were very limited. Only about 20% and 3% received family planning counseling and contraceptive methods respectively. Other reproductive health related issues such as STIs and HIV/AIDS were rarely raised by the service providers during caring for the patients. Overall 92.3% of the patients responded that they were satisfied with the services they have received. CONCLUSION: The study has shown several missed opportunities and indicated important areas for future service delivery improvement.     

A systematic review of effect of prenatal zinc supplementation on birthweight: meta-analysis of 17 randomized controlled trials

The effect of prenatal zinc supplementation on birthweight is controversial as randomized controlled trials (RCTs) report conflicting conclusions. A systematic review which includes meta-analysis was done on 17 RCTs conducted worldwide since 1984 to assess the effect of prenatal zinc supplementation on birthweight. The studies were identified through web-based search. Heterogeneity among studies was assessed using Cochrane Q test statistic. Effect-size was measured based on standardized mean difference. Pooled effect-size was computed using a variant of random effect model. Thirteen of the 17 RCTs found no association, three reported positive association, and one reported negative association. Based on fixed and random effect models, the pooled effect-sizes were 0.0268 [95% confidence interval (CI) 0.0764, -0.0229) and 0.0712 (95% CI 0.1619, -0.0194) respectively. The effect-size estimate remains insignificant after stratification was made based on the dose of supplementation (optimal vs high dose), type of study (community vs institution-based), and type of source country (developed vs developing). The meta-analysis did not witness any association between birthweight and prenatal zinc supplementation.     

Perinatal Survival and Predictors of Mortality among Mothers with Hypertensive Disorders of Pregnancy at Antenatal care Clinics in Gamo Zone Public Hospitals

BackgroundPregnancy induced hypertension represents a significant public health problem throughout the world, which may complicate 0.5%–10% of all pregnancies. It is the leading cause of maternal as well perinatal mortality and morbidity worldwide. Pregnancy induced hypertension is a multisystem disorder unique to pregnancy and results in high perinatal mortality. The objective of this study was to determine the survival status, incidence and predictors of perinatal mortality among mothers with pregnancy induced hypertension at antenatal clinics of Gamo Zone public hospitals.MethodsFacility-based retrospective cohort study was conducted among selected 576(192 exposed and 384 unexposed) antenatal care attendants'' record at Gamo Zone public hospitals from 1^st January 2018 to 31^st December 2018. Data were entered into Epi data version 3.02 and exported to SPSS V 25 for analysis. Kaplan Meier survival curve together with log rank test was fitted to test the survival time. Statistical significance was declared at P-value ≤0.05 using cox proportional hazard model.ResultThe incidence of perinatal mortality was 124/1000 births. The cumulative proportion of surviving at the end of 4^th, 8^th, 12^th and 16^th weeks of follow-up among the exposed groups was 96.9%, 93.5%, 82.1% and 61.6% respectively whereas it was 99.5%, 98.9% and 98.5% at the end of 4^th, 8^th and 12^th weeks of follow-up for the non-exposed groups respectively. Parity of ≥5(AHR: 6.3; 95%CI: 1.36,10.55), mothers who delivered at <34 weeks of gestation(AHR:7.8; 95%CI: 2.6,23.1), being preterm(AHR:6; 95%CI: 5.3,19.2), perinatal birth weight ≤2500gm(AHR:6.1; 95&CI: 1.01,37.9), vaginal deliveryn(AHR:2.7; 95%CI:1.13,6.84), maternal highest systolic blood pressure level ≥160mmHg (AHR: 2.3; 95%CI: 1.02,5.55) and prepartum onset of pregnancy induced hypertension (AHR: 6; 95%CI: 5.3,19.2) were statistically significant in multivariable analysis.ConclusionThe risk of perinatal mortality was high among the mothers with pregnancy induced hypertension compared to those of pregnancy induced hypertension free mother,s and the perinatal mortality rate was high. High parity, low gestational age, low number of antenatal care visits, low birth weight, vaginal delivery, antepartum onset of pregnancy induced hypertension and highest maternal systolic blood pressure level were the independent predictors of perinatal mortality.