Attitudes of modern and traditional medical practitioners toward cooperation

Between 1985 and 1987 a total of 103 modern and 91 traditional medical practitioners were interviewed in seven towns in northwestern and central Ethiopia. The main aim was to assess their attitudes toward the legitimacy of each other's medical system and, especially, toward the question of cooperation or integration between modern and traditional medicine. It was found that the majority of the two groups of health workers believed that cooperation between the two systems of medicine would be useful and that they themselves would be willing to participate in such cooperative efforts. Those willing to cooperate suggested that traditional healers be (1) brought into the existing, official health-care settings, (2) given regular government wages for their services, and (3) guided and supervised by their modern counterparts.     

Effects of mavacamten on Ca2+ sensitivity of contraction as sarcomere length varied in human myocardium

Background and PurposeHeart failure can reflect impaired contractile function at the myofilament level. In healthy hearts, myofilaments become more sensitive to Ca²⁺ as cells are stretched. This represents a fundamental property of the myocardium that contributes to the Frank–Starling response, although the molecular mechanisms underlying the effect remain unclear. Mavacamten, which binds to myosin, is under investigation as a potential therapy for heart disease. We investigated how mavacamten affects the sarcomere‐length dependence of Ca²⁺‐sensitive isometric contraction to determine how mavacamten might modulate the Frank–Starling mechanism.Experimental ApproachMulticellular preparations from the left ventricular‐free wall of hearts from organ donors were chemically permeabilized and Ca²⁺ activated in the presence or absence of 0.5‐μM mavacamten at 1.9 or 2.3‐μm sarcomere length (37°C). Isometric force and frequency‐dependent viscoelastic myocardial stiffness measurements were made.Key ResultsAt both sarcomere lengths, mavacamten reduced maximal force and Ca²⁺ sensitivity of contraction. In the presence and absence of mavacamten, Ca²⁺ sensitivity of force increased as sarcomere length increased. This suggests that the length‐dependent activation response was maintained in human myocardium, even though mavacamten reduced Ca²⁺ sensitivity. There were subtle effects of mavacamten reducing force values under relaxed conditions (pCa 8.0), as well as slowing myosin cross‐bridge recruitment and speeding cross‐bridge detachment under maximally activated conditions (pCa 4.5).Conclusion and ImplicationsMavacamten did not eliminate sarcomere length‐dependent increases in the Ca²⁺ sensitivity of contraction in myocardial strips from organ donors at physiological temperature. Drugs that modulate myofilament function may be useful therapies for cardiomyopathies.     

Khat use among HIV voluntary counselling and testing centre clients in Ethiopia

Khat (Catha edulis, a natural stimulant), has been used in Ethiopia for centuries. Over the past few decades, however, its use has dramatically increased, with recent research linking khat use to HIV status. Using qualitative methods, we explored the individual and micro-environmental characteristics of khat use and the social and physical contexts influencing type, acceptability and consequences of khat use. Among khat chewers attending an HIV voluntary counselling and testing centre in Addis Ababa, Ethiopia, we found that chewing typically starts at an early age (15–18 years). The majority of users are young (aged 18–35) and chew for pleasure, primarily in social settings. Over 25 types of khat, with varying effects were reported. Approximately half of the participants perceived khat to enhance sexual desire, while the rest claimed the effect on sexual desire to be the opposite. Alcohol use among chewers was high. Our findings suggest the need for culturally appropriate interventions that highlight the factors associated with khat use and the potential interplay between khat, alcohol and risky sexual behaviour.     

Knowledge and practice concerning malaria,insecticide-treated net (ITN) utilization and antimalarial treatment among pregnant women attending specialist antenatal clinics

Aim  

This study was conducted to determine the knowledge and practice of pregnant women attending specialist antenatal clinics (ANCs) concerning malaria, ITN (insecticide-treated net) utilization and antimalarial treatment.     

Inhibition of cyclooxygenase-2 in the rat renal medulla leads to sodium-sensitive hypertension

Cyclooxygenase-2 expression in the renal medulla is regulated by dietary salt intake. The present study was performed to determine the influence of chronic inhibition of medullary cyclooxygenase-2 on arterial blood pressure in conscious Sprague-Dawley rats maintained on a high-salt (4% NaCl) or a low-salt (0.4% NaCl) diet. Rats were uninephrectomized and instrumented with femoral arterial and femoral vein or renal medullary interstitial catheters. Each rat received a continuous medullary or intravenous infusion of saline (0.5 mL per hour) for 3 control days, followed by infusion of the cyclooxygenase-2 inhibitor NS-398 (10 mg/kg per day) for 5 days. Medullary interstitial infusion of NS-398 significantly increased mean arterial pressure in the 4% NaCl group from 126+/-2 to 146+/-2 mm Hg (n=6) but did not alter blood pressure in the 0.4% NaCl group (n=6). Intravenous infusion of NS-398 to rats on the 4.0% NaCl diet also failed to alter mean arterial pressure (n=5). To test the blood pressure effect of a mechanistically different inhibitor of cyclooxygenase-2, an antisense oligonucleotide against cyclooxygenase-2 (18-mer; 8 nmol per hour) was infused into the renal medulla of rats maintained on a high-salt diet. Administration of the antisense oligonucleotide reduced cyclooxygenase-2 immunoreactive protein by 36% and significantly increased mean arterial pressure from 127+/-2 to 147+/-2 mm Hg (n=6). Renal medullary interstitial infusion of a scrambled oligonucleotide did not alter arterial pressure (n=5). These results demonstrate the importance of cyclooxygenase-2 in the renal medulla in maintaining blood pressure during high-salt intake.     

Effects of a participatory community quality improvement strategy on improving household and provider health care behaviors and practices: a propensity score analysis

Background

Maternal and newborn health care intervention coverage has increased in many low-income countries over the last decade, yet poor quality of care remains a challenge, limiting health gains. The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services, responsive to community needs. Aligned with this, a Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers’ and households’ practices.

Methods

PCQI engages communities in identifying barriers to access and quality of services, and developing, implementing and monitoring solutions. Thirty-four intervention kebeles (communities), which included the L10 K Platform, BEmONC, and PCQI, and 82 comparison kebeles, which included the L10 K Platform and BEmONC, were visited in December 2010–January 2011 and again 48 months later. Twelve women with children aged 0 to 11 months were interviewed in each kebele. Propensity score matching was used to estimate the program’s average treatment effects (ATEs) on women’s care seeking behavior, providers’ service provision behavior and households’ newborn care practices.

Results

The ATEs of PCQI were statistically significant (p?<?0.05) for two care seeking behaviors — four or more antenatal care (ANC) visits and institutional deliveries at 14% (95% CI: 6, 21) and 11% (95% CI: 4, 17), respectively — and one service provision behavior — complete ANC at 17% (95% CI: 11, 24). We found no evidence of an effect on remaining outcomes relating to household newborn care practices, and postnatal care performed by the provider.

Conclusions

National BEmONC strengthening and government initiatives to improve access and quality of maternal and newborn health services, together with L10 K Platform activities, appeared to work better for some care practices where communities were engaged in the PCQI strategy. Additional research with more robust measure of impact and cost-effectiveness analysis would be useful to establish effectiveness for a wider set of outcomes.

     

Probable Vanishing White Matter Disease: A Case Report and Literature Review

BackgroundVanishing white matter disease is one of the most prevalent inherited childhood leukoencephalopathies. The disease is characterized by chronic, progressive and episodic deterioration with ataxia and spasticity.Case PresentationHere, we report a 15-month-old female child from Dire-Dawa, eastern part of Ethiopia, who presented with regression of developmental milestones and truncal ataxia since her age of 11 months following a febrile illness that occurred one month earlier. Magnetic resonance imaging of brain is suggestive of vanishing white matter disease.ConclusionsWe believe this case report will increase curiosity, awareness and knowledge of health professionals in Ethiopia and sub-Saharan Africa working with children in early consideration and the diagnosis of the disease.     

Promoting traditional medicine in Ethiopia: a brief historical review of government policy

Past and current official policy toward Ethiopian traditional medicine is reviewed. To facilitate the objective assessment of official policy, the nature and historical origins of Ethiopian traditional medicine is examined briefly. It is noted that there is no single system of traditional medicine in Ethiopia, even though themes that are common to the many cultural groups constituting the society have been evolving. Common to most systems of Ethiopian traditional medicine are the interdigitation of 'mystical' and 'natural' explanations of ill-health and other misfortune and the holistic approach employed in dealing with illness and other personal misfortune. It is also noted that since the 1974 change of government in Ethiopia, official attitude toward the promotion and development of traditional medicine appears to have become more positive, especially, after the adoption of the Primary Health Care strategy in 1978. While this is true as far as official statements are concerned, in actual practice there continues to be considerable uncertainty about the interpretation and implementation of Government policy. It is suggested that misconceptions regarding the nature and role of traditional medicine in Ethiopian society will have to be corrected if appropriate plans and strategies are to be formulated.