A community based study of urogenital chlamydia trachomatis in males aged fifteen years and above,Dembia District,northwest Ethiopia

Chlamydia trachomatis is one of the most common causes of sexually transmitted diseases in sexually active males and females. Infertility is one of the serious complications of urogenital chlamydial infections. This study was carried out in Chuwahit town and the surrounding village, which is located southwest of Gondar town. The main objective was to estimate the prevalence of urogenital Chlamydia trachomatis among males aged fifteen years and above. The design used was a cross sectional survey. First catch urine was collected from males 15 years and above and interviews were made using a questionnaire. The urine samples were tested with an Enzyme Immuno-Assay (EIA), which is useful in rapid detection of chlamydia antigen. Among 199 males included in the study, thirty-three (16.6%) had laboratory evidence of urogenital Chlamydia trachomatis. The mean (SD) age of the study subjects was 29.3 (+/- 9) years. Students (8 out of 21, 38%) had the highest prevalence of urogenital Chlamydia compared to the other groups (OR = 4.10, 95% CI = 1.12, 14.48). The magnitude of urogenital chlamydia infection in males was high in the study area. Health professionals need to consider genital Chlamydial infections in the management and control of sexually transmitted diseases. Increasing the awareness of students towards urogenital Chlamydial trachomatis and teaching them about the benefits of using condoms is recommended.     

Antinutritional factors and in vitro protein digestibility of improved haricot bean (Phaseolus vulgaris L.) varieties grown in Ethiopia

The antinutrient (raffinose oligosaccharides, tannins, phytic acid and trypsin inhibitors) composition and in vitro protein digestibility of eight improved varieties of Phaseolus vulgaris grown in Ethiopia were determined. Stachyose was the predominant alpha-galactosides in all haricot bean samples. Raffinose was also present in significant quantities but verbascose, glucose and fructose were not detected at all in the samples. The concentrations observed for the protein digestibility and antinutritional factors, varied significantly (P<0.05) between varieties investigated in this study. Mean values for protein digestibility ranged from 80.66% (in Roba variety) to 65.64% (in Beshbesh variety). Mean values for raffinose, stachyose, sucrose, trypsin inhibitors, tannins and phytic acid were 3.14 mg/g, 14.86 mg/g, 24.22 mg/g, 20.68 TUIx10(3)/g, 17.44 mg, catechin equivalents/g and 20.54 mg/g respectively. Statistical analyses of data revealed that antinutritional factors and protein digestibility were influenced by variety (genotype). Relationships between antinutritional factors and protein digestibility were also observed. The possibility of selecting varieties to be used for large-scale cultivation in Ethiopia on the basis of these data is discussed. Among the improved varieties studied, Roba, Redwolaita, Mexican and Awash were found to be the best food and export type of haricot beans in the Ethiopian context, because of their higher protein digestibility, lower antinutrtional factors and other beneficial nutritional parameters. Roba variety can be used by local food processors for the production of value-added bean-based products especially to combat the problem of protein energy malnutrition and related diseases which are very common in developing countries.     

Vaccination coverage survey versus administrative data in the assessment of mass yellow fever immunization in internally displaced persons--Liberia, 2004

Yellow fever (YF) is a mosquito-borne vaccine-preventable disease with high mortality. In West Africa, low population immunity increases the risk of epidemic transmission. A cluster survey was conducted to determine the effectiveness of a mass immunization campaign using 17D YF vaccine in internally displaced person (IDP) camps following a reported outbreak of YF in Liberia in February 2004. Administrative data of vaccination coverage were reviewed. A cluster sample size was determined among 17,384 shelters using an 80% vaccination coverage threshold. A questionnaire eliciting demographic information, household size, and vaccination status was distributed to randomly selected IDPs. Data were analyzed to compare vaccination coverage rates of administrative versus survey data. Among 87,000 persons estimated living in IDP camps, administrative data recorded 49,395 (57%) YF vaccinated persons. A total of 237 IDPs were surveyed. Of survey respondents, 215 (91.9%, 95% CI 88.4-95.4) reported being vaccinated during the campaign and 196 (83.5%, 95% CI 78.6-88.5) possessed a valid campaign vaccination card. The median number of IDPs living in a shelter was 4 (range, 1-8) and 69,536 persons overall were estimated to be living in IDP camps. Coverage rates from a rapid survey exceeded 90% by self-report and 80% by evidence of a vaccination card, indicating that the YF immunization campaign was effective. Survey results suggested that administrative data overestimated the camp population by at least 20%. An emergency, mop-up vaccination campaign was avoided. Coverage surveys can be vital in the evaluation of emergency vaccination campaigns by influencing both imminent and future immunization strategies.     

Preference Weighting of Health State Values: What Difference Does It Make,and Why?

Background

Most patient-reported outcome measures apply a simple summary score to assess health-related quality of life, whereby equal weight is normally assigned to each item. In the generic preference-based instruments, utility weighting is essential whereby health state values are estimated through preference elicitation and complex algorithms.

Clinical, microbiological and antibiotic susceptibility patterns of diarrhoea in Korem, Ethiopia

Two hundred patients with diarrhoea in a rehabilitation camp in Ethiopia were studied in October 1985 to determine the presence of pathogens in the stool and their susceptibility to antibiotics. A total of 42 (21.1%) patients had a positive culture with enterobacteriaceae, the isolation rate was 15.6% for Escherichia coli, 3.5% for Shigella spp. and 2.01% for Salmonella spp. In-vitro antibiotic resistance was frequent among the 42 isolates: 53% of E. coli strains were found to be resistant to ampicillin, 47% to chloramphenicol, 30% to co-trimoxazole and 67% to tetracycline. Of the seven Shigella, three were resistant to chloramphenicol and four to tetracycline. Multidrug resistance (two or more antibiotics) was observed in 52.3% of the 42 isolates. The protocols used for the screening of dysenteric patients for Shigella spp. or Salmonella spp. were found to be specific but poorly sensitive. The opposite was observed for amoebiasis and giardiasis. The responsibility of widespread use of common oral antibiotics is discussed as one of the major factors of antibiotic resistance occurrence at Korem.     

Do country-specific preference weights matter in the choice of mapping algorithms? The case of mapping the Diabetes-39 onto eight country-specific EQ-5D-5L value sets

Purpose

To develop mapping algorithms that transform Diabetes-39 (D-39) scores onto EQ-5D-5L utility values for each of eight recently published country-specific EQ-5D-5L value sets, and to compare mapping functions across the EQ-5D-5L value sets.

Methods

Data include 924 individuals with self-reported diabetes from six countries. The D-39 dimensions, age and gender were used as potential predictors for EQ-5D-5L utilities, which were scored using value sets from eight countries (England, Netherland, Spain, Canada, Uruguay, China, Japan and Korea). Ordinary least squares, generalised linear model, beta binomial regression, fractional regression, MM estimation and censored least absolute deviation were used to estimate the mapping algorithms. The optimal algorithm for each country-specific value set was primarily selected based on normalised root mean square error (NRMSE), normalised mean absolute error (NMAE) and adjusted-r². Cross-validation with fivefold approach was conducted to test the generalizability of each model.

Results

The fractional regression model with loglog as a link function consistently performed best in all country-specific value sets. For instance, the NRMSE (0.1282) and NMAE (0.0914) were the lowest, while adjusted-r² was the highest (52.5%) when the English value set was considered. Among D-39 dimensions, the energy and mobility was the only one that was consistently significant for all models.

Conclusions

The D-39 can be mapped onto the EQ-5D-5L utilities with good predictive accuracy. The fractional regression model, which is appropriate for handling bounded outcomes, outperformed other candidate methods in all country-specific value sets. However, the regression coefficients differed reflecting preference heterogeneity across countries.

     

Health state utility instruments compared: inquiring into nonlinearity across EQ-5D-5L,SF-6D,HUI-3 and 15D

Purpose

Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated nonlinear relationships. This paper inquires into the degree of nonlinearity across the four most widely used HSU-instruments and proposes exchange rates that differ depending on the severity levels of the health state utility scale.

Methods

Overall, 7933 respondents from six countries, 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of nonlinear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument.

Results

Quantile regressions reveal significant nonlinear relationships across all four HSU-instruments. The degrees of nonlinearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.11, whilst at the upper end it is 0.38.

Conclusion

Comparisons at different utility levels illustrate the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of nonlinear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument been used. Accounting for nonlinearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY gains have been based on different HSU-instruments.