Center In Ethiopia Research Articles

Longer-term effectiveness of protease-inhibitor-based second line antiretroviral therapy in four large sub-Saharan African clinics

Data on the longer-term effectiveness of second line combination antiretroviral therapy (ART) in sub-Saharan Africa (SSA) are lacking. We sought to assess the probability and determinants of 2nd line ART failure in SSA. A retrospective, multi-center study of 2nd line ART initiated between 2005 and 2017 at four ART centers in Ethiopia, Ghana and Uganda. Main outcome measure was virologic failure (VF) defined as VL>1000 copies/ml after >6 months on 2nd line therapy. Predictors of VF and virologic re-suppression on 2nd line were evaluated using Cox Proportional Hazards and multivariable logistic regression models, respectively. 2191 subjects started 2nd line therapy, 61.5% females. Switching from 1st line (56.4% NVP-based, 70.3% including thymidine-analogues) to 2nd line therapy occurred after mean of 4.1 years. 98.9% of patients started boosted PI with NRTI backbone (TDF+3TC/FTC 67.3%, AZT+3TC 18.5%, others 14.2%). There were 267 (12.0%) VF with a 5-year estimated probability of 15.0% (95% CI 13.2-16.9). Key determinants of VF were concomitant rifampicin use (aHR 2.50 [95% CI 1.54-4.05]) and clinical/immunological failure versus virologic failure as reason for switching therapy (aHR, 0.53 [0.33-0.86]). 138 of 267 (51.7%) subsequently achieved virologic re-suppression and predictors included HIV RNA levels at 2nd-line failure: +1 log higher aOR 0.59 [0.43-0.80], experiencing change within 2nd line ART before VF: aOR 0.17 [0.05-0.56], and more recent calendar year of 2nd line initiation: aOR 0.85 [0.75-0.94]. The effectiveness of current 2nd line ART regimens in SSA is good but challenged by interactions with TB therapy.

Ethnicity across regional boundaries: migration and the politics of inequality in Ethiopia

ABSTRACT Increasing migration across the world has transformed the politics of identity in recent decades, which has influenced how people experience and narrate ethnicity. The rigid Ethiopian political system of ethnic federalism makes ethnicity an official and permanent component of individual identity and group belonging to ethnic-based regions. At the same time, the government has enabled increased internal migration and facilitated ethnic diversity on university campuses. In this article, I explore experiences of migration across regional boundaries among people from the Tigray region towards ethnically diverse urban centers in Ethiopia, such as Addis Ababa. This paper illustrates how an emic conceptualisation of identity can be understood as a response to state categories of ethnicity, but also argues that contextual and temporal politics generate conditions and experiences that in turn reshape those conceptualisations.

District-level health management and health system performance.

Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings; however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. In districts with above median district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. In districts with below median management capacity, health center management capacity was not associated with KPI performance. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings.

Nutritional Composition Analysis of Improved and Released Rice Varieties in Ethiopia

The nutritional composition of ten improved and released rice varieties collected from different research centers in Ethiopia were analysed in Assosa agricultural and nutritional research laboratory. The percent of moisture, ash, crude fat, crude protein, crude fiber, carbohydrate and total energy were 9.78-11.93%, 0.62-1.63%, 1.14-2.57%, 8.41-11.77%, 1.58-3.38%, 74.96-78.03% and 365.35-376.92 kcal (100g)-1 respectively. The analysis of variance shows that the proximate compositions of most rice varieties are significantly different (p < 0.05). Pawe-1 rice variety has good source of protein and total energy. On the other hand, TANA rich in carbohydrate content, Kokit is a good source of fat and SUPARICA-1 rich in crude fiber relative to improved and released rice varieties studied. Therefore, End users can be selecting these rice varieties according to the indicated percent of proximate analysis result and their preference for food formulation, nutrition and other purpose.

Epidemiology of Esophageal Cancer (EC) In Oromia Region, Ethiopia 2016: A 4-Year Medical Record Review

Background: It is difficult to determine the prevalence/incidence of EC without an established functional national cancer registry, which helps to demarcate the population at-risk and monitor cancer trends over time. The review of medical records can help to identify areas in a country with high number of diagnosed EC cases and help set public health priorities. Aim: To describe EC hospital case series during a period of 4 years at the main cancer treatment center in Ethiopia and two hospitals in the EC high-risk zones in the Oromia region, concentrating on residents of Oromia region and to offer recommendations for public health officials. Methods: All EC malignancy data from the period 2013-2016 were collected by reviewing patient charts at the selected hospitals: Tikur Anbessa Teaching hospital (TATH) in Addis Ababa, Adama General and Medical Teaching Hospital (AGMTH) and Adama Referral and Medical Teaching Hospital (ARMTH). Cases with insufficient residence information and residents of other regions were excluded from the summary. The number of EC cases is presented by age, sex and site as well as method of diagnosis. Data were expressed as percentages (%). Statistical analysis was done using SPSS 20 software. Results: Over the study period, a total of 669 EC cases who resided in Oromia region were identified in the selected hospitals out of 2211 registered in the referral surgical departments of hospitals in the study, with insignificant difference by sex. A total of 457 (68%) were residents from high risk Arsi/Bale zones and the rest 212 (32%) from other zones of the region. The mean age at diagnosis was 52.4 years with the majority of cases in the age range 45-69 years. A total of 34 (5%) EC cases were younger at diagnosis (15-29 years). A total of 258 (38.5%) cases were identified at TATH, 305 (46%) from AGHMT/ARHMT and 106 (16%) cases from both TATH/AGHMT. Data were gathered from patient charts at endoscopy departments 227 (34%), endoscopy and pathology departments 246 (37%) and all other sources (ie surgical department) 196 (29%). Most patients complained dysphagia for solids 664 (99%) and weight loss 352 (53%). Cases were histopathology proven (256, 38%), identified through endoscopy investigation (385, 58%) or radiology (28, 4%). Squamous cell carcinoma was the predominant histology type with 160 cases (62.5%) of those histologically proven. Among the total of 420 cases whose risk factor history was recorded, 401 (97%) had a previous history of digestive disease, 49% reported hot beverage consumption and 34% persistent heart burn. Conclusion: Two thirds of EC incident cases came from Arsi and Bale zones with decreasing trends over the period considered. Such trends warrant in depth investigation for possible reasons and future study to investigate local based risk factors associated with the disease.

GIS based quantification and mapping of climate change vulnerability hotspots in Addis Ababa

BackgroundUnlike the studies undertaken on agricultural and hydrological sectors, focused climate change vulnerability researches in urban centers in Ethiopia is not widely available and of recent history. However, as many signals of climate change vulnerability started to happen in urban centers as well, it is inevitable to analyze, quantify, map, prioritize and be prepared for adaptation measures. This study is therefore, tried to assess, quantify and map climate change vulnerability in Addis Ababa, Ethiopia, by integrating two climate change vulnerability assessment models, namely, the Sullivan and Meigh’s Model of composite climate change vulnerability index and the IPCC’s approach of vulnerability assessment which comprises exposure, sensitivity and adaptive capacity. Fifteen sub-components of vulnerability indicators were identified in ten sub-cities (Addis Ketema, Arada, Akaki-Kality, Bole, Gulelle, Kirkos, Kolfe-Keraniyo, Lideta, Nifasilk-Lafto and Yeka) of Addis Ababa. Due to the scale, degree, amount and unit of measurement for the selected indicators varied, their values were normalized to a number which ranges between 0 and 1, indicating as the values increased to 1, vulnerability to climate change increases. The study uses Iyengar and Sudarshan’s unequal weighting system, to assign a weight to all indicators. The results were mapped using ArcGIS 10.2 package.ResultsThe results indicated that the ten sub-cities in Addis Ababa were found in different levels of vulnerability to climate change. The exposure and sensitivity were highest for Addis Ketema, Arada, and Lideta which are found in central parts of the city, with a normalization index value greater than 0.5. The adaptive capacity index is the highest in Gulelle, Bole, and Arada sub-cities. These sub-cities have better quality houses, well-planned districts, good infrastructural facilities and good coverage of green areas compared to others. The overall climate change vulnerability was the highest (normalized index > 0.5) in Arada, Addis Ketema and Lideta, due to the adaptation capacity is the lowest compared to other sub-cities.ConclusionAddis Ababa is vulnerable to climate change impacts and the degree of vulnerability is underpinned by the interaction of multiple factors mainly adaptive capacities of sub-cities, location based characteristics and changes in climatic parameters. These present a need to strengthen mitigation and adaptation activities and prioritize sub cities for intervention based on the degree of vulnerability. It is also understood that the Sullivan and Meigh’s Model and IPCC’s approach for climate change analyses, could be used simultaneously for preparing vulnerability index per different geographical locations.

Incidence and causes of cancellations of elective operation on the intended day of surgery at a tertiary referral academic medical center in Ethiopia

BackgroundElective surgical case cancellation refers to any elective surgical case that is the list on the day prior to surgery but not operated upon as scheduled. Case cancellation has a major cause of psychological trauma to patients and their families. Despite little is known in Ethiopia. Therefore, this study aimed to assess incidence and reasons of cancellations of elective operation on the intended day of surgery at tertiary referral academic medical center in Ethiopia.MethodsA prospective hospital-based cross-sectional study design was conducted in a tertiary referral academic medical center in Ethiopia among 146 participants. A self-administered questionnaire with an observatory checklist was used for collecting data from the anesthetist, nurse, and surgeons.ResultIn this study, 462 patients were scheduled for elective surgical operations. Among those, nearly almost one-third 146 (31.6%) of the operations were cancelled and 316 (68.4%) patients were operated on their planned date. The most common reason for cancellation were surgeon related (35.8%), patient related (28.7%), management related (21.2%) and anesthesia related factors (14. 4%). The cancellation was mainly due to improper scheduling (20.5%%), unavailability of surgeons (8.9%), unavailability of oxygen and blood (8%) and equipment (5.5%). Orthopedic (28.8%) and general surgery (17.1%) were the commonest cancelled cases.ConclusionThe cancellation rate in our academic medical center remains high. Improper scheduling, unavailability of surgeons, medical illness, and unavailability of operating room equipment were the commonest reason for the cancellation of elective operation. Most cancellations were preventable. For this, proper preoperative assessment, proper scheduling, fulfilling necessary operating room equipment’s and cross-matched blood by the hospital and other stakeholders, early clear communication with operating room team like surgeons was recommended.

Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia

PurposeAlthough information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia.MethodsMastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings.ResultsFewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list.ConclusionMore than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.

Live Donor Kidney Transplant Outcomes Till February 2018 in the First Kidney Transplant Center in Ethiopia

Background Kidney transplantation is the preferred treatment for patients with end stage renal failure in industrialized countries, but its availability is very limited in Sub-Saharan Africa. In Ethiopia, this option was accessible for only those few who could afford to travel abroad with their living donors for donation and transplantation. In collaboration with faculty from the University of Michigan (UM), the Federal Democratic Republic of Ethiopia, National Kidney Transplant Center, the first Ethiopian kidney transplant program, was launched at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa in Sept 2015. This study reports on live donor and recipient kidney transplant outcomes to date. Methods This is a retrospective cross sectional qualitative study of live kidney transplant performed at Saint Paul Hospital Millennium Medical College. Results This study reports on live donor and recipient kidney transplant outcomes to date. From September 2015 through February 2018, a total of 70 live kidney transplants were performed at Saint Paul’s Hospital Millennium Medical College (SPHMMC). All procedures were performed by SPHMMC transplant team in collaboration with University of Michigan faculty and later experiences from Hospital Do Rim Sao Paulo Brazil was incorporated. All of recipients were 1st time recipients HLA typing and crossmatch were performed off site B and T cell crossmatch were negative by the CDC method in all patients None of the recipients have significant titer of Anti-HLA antibodies. Majority of donors were females (53.8%) and majority of recipients were males (60%). Donor age ranged from18 to 66 with a mean of 30.2 years. Mostly donors were siblings (40%) or parents (12%) of the recipient. Donor Outcomes 47 were initially hand assisted Laparoscopic nephrectomies (one conversion) with conversion rate of 6.7 % (due to intraperitoneal adhesions ), the remaining twenty three were open donor nephrectomi with after an experience sharing at hospital Do rim in Brazil(a mini-incision (~10 cm) open donor nephrectomy technique has been utilized). There was 100% survival, two re -hospitalization for lymphocele. 1 donor complication – Heamopneumothorax,and Small bowel obstruction requiring exploration, Prolonged hospital stay (14 days) and another with major bleeding during open donor nephrectomy. Recipient Outcome There was only one hyper-acute rejection and four graft censored death one having superficial surgical site infection and one suffering from Atelectasis. Conclusion Despite challenges arising from a resource-limited setting, outcomes of Living Donor Kidney Transplantations (LDKT) performed at SPHMMC are comparable to international standards. Blending experiences from different countries and evolving into a more suitable contextual implimentation of LDKT makes the prospects for sustainable Living Donor Transplantation in Ethiopia are promising. Ethiopian Mistry of Health.

Patient Characteristics and Outcomes Following Establishment of a Living Donor Kidney Transplant Program in Sub-Saharan Africa

Background End-stage renal disease (ESRD) is one of the most common non-communicable causes of death. ESRD’s effects are significantly worse in the economically underprivileged parts of African society where renal replacement therapy such as dialysis or kidney transplantation is not available, as it is both scarce and unaffordable for most patients and families. About 2 years ago, we established Ethiopia’s first living donor kidney transplant program. Herein, we sought to describe the patient characteristics and outcomes of our living donor kidney program. Methods We retrospectively analyzed all ESRD patients who received kidney transplantation at the Ethiopian Ministry of Health National Kidney Transplant Center, located at St. Paul’s Hospital Millennium Medical College in Addis Ababa. All patients underwent living donor kidney engraftment from September 2015 to August 2017. Results After about 3 years of planning prior to human transplants, a total of 52 living donor kidney transplants were performed, of which 20 were performed in the first year. Of these, 40 recipients (76.9%) were male. Recipient age ranged from 16 to 60 years, with a mean of 34.5 years, and a mean BMI of 20.1 (range 15.3-30.6). Geographically, the majority of patients were from Addis Ababa (71.2%). Due to a relative lack of access for pre-transplant biopsy, the cause of ESRD was unknown in many patients (63.5%). All patients received left donor kidneys, and the majority was placed on the recipient’s left external iliac artery (88.5%). The mean operation time and blood loss were 148 minutes and 120 mL, respectively. The mean length of stay was 8.1 days (SD=4.1). There were a total of 9 surgical complications (6 early and 3 late) in 7 patients, with superficial surgical site infection (SSI) being the most common (4). There were no patient deaths during the immediate postoperative period. Conclusions We have successfully established the first kidney transplant center in Ethiopia. While training for faculty and staff are ongoing, our results so far are comparable to other international centers. Key words: ESRD, Kidney Transplant, Outcomes

Factors which contributed for low quality sputum smears for the detection of acid fast bacilli (AFB) at selected health centers in Ethiopia: A quality control perspective.

ObjectivesQuality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of External Quality Assurance (EQA) service in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia.MethodsA cross-sectional study was carried out between July 8, 2014 and July 7, 2015.A pre-tested structured questionnaire was used to collect data. Lot Quality Assurance Sampling (LQAS) method was put into practice for collecting all necessary sample slides. Data were analyzed by using SPSS (Statistical Package for Social Sciences) version 20 software. P-value < 0.05 was considered as statistically significant.ResultsOf the total55 health center laboratories which had been assessed during the study period, 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. Moreover, poor specimen quality, smear size, smear thickness, staining and evenness were indicated in 40 (72.7%), 39 (70.9%), 37 (67.3%), 27(49.1%) and 37 (67.3%) of the collected samples, respectively. False negative AFB findings were significantly associated with lack of Internal Quality Control (IQC) measures (AOR (Adjusted Odds Ratio): 2.90 (95% CI (Confidence Interval): 1.25,6.75) and poor staining procedures (AOR: 2.16(95% CI: 1.01, 5.11).ConclusionsThe qualities of AFB smear microscopy reading and smearing were low in most of the laboratories of the health centers. Therefore, it is essential to strength EQA program through building the capacity of laboratory professionals.

CURRENT STATUS OF CLINICAL TRIALS IN ETHIOPIA:HOW MUCH IS DONE?

Introduction: Clinical trials are a cornerstone of modern evidence based medicine. They are an important step in discovering new treatments for certain diseases as well as new ways to detect, diagnose, and reduce the risk of disease. They also highly support the clinical practice by generating local evidence. The aim of this study is to evaluate the status and trend of clinical trials in Ethiopia from international trial registries. Material and Methods: We have searched WHO International Clinical Trial Registry Platform (WHO ICTRP) for all trials with at least one recruitment center in Ethiopia. The results were exported in XML format and a rational database was formed. Results: Up to November 15,2016; 145 clinical trials were found to be registered from Ethiopia. Majority of trials were design on infectious disease (n = 87, 60%) and the rest were done on NCD. The five most common infectious disease evaluated were Malaria (n=15; 10%), Tuberculosis (n=13; 9%), trachoma (n=12; 8%), HIV (n=11; 8%) and helminthiasis (n=6; 4%). The most common NCD was malnutrition (n = 19; 13%) and only one trial was on cancer, namely Wilms Tumor (1%). London School of Hygiene and Tropical Medicine was the sponsor with the highest number of registered trials (n=8, 6% of all trials), followed by Columbia, Jimma and Ghent University with 5 (3%) trials each. Conclusions: The clinical trials done in Ethiopia are very much limited in number and variety. To improve the situation the government, industry, academic institutions, patient advocacy groups, professional societies and other organizations should work together.

Evaluating the Effects of Deficit Irrigation on Yield and Water Productivity of Furrow Irrigated Onion (Allium cepa L.) in Ambo, Western Ethiopia

The objective of this study was, to evaluate the effects of deficit irrigation on yield and water productivity (WP) of onion crop grown under Ambo condition. Field experiment was conducted at Ambo Agricultural Research Center in Ethiopia. The treatments consisted of nine different treatments replicated three times arranged in RCBD. The experiment involved two categories of deficit with different timings: 1) skipping of irrigation during one particular phenological stage and application of 75% ETc during the rest of the growing stages and 2) no watering during specific phenological stage and watering with 50% ETc during the remaining stages. Amount of water applied was monitored using standard Parshall flume. The highest total onion yield (46.7t/ha) was obtained from full irrigated treatment, which was not statically different from treatments that were not irrigated during initial growth stage and irrigated with 75% ETc during the rest of phenological stages (T2) and treatment with no irrigation during bulb maturity stage and irrigated with 75% ETc otherwise (T5) (P<0.05). The second category of treatment (irrigation with 50% ETc) resulted high water saving and yield reduction which may not be attractive for producers. WP varied from 7.7 kg/m3 for control and 14.9 kg/m3 for the 50% stressed and not irrigated during maturity stage. T2 and T5 produced WP values of 10.8 and 13.1 kg/m3 respectively. From resources conservation point of view, maximum water productivity may be of interest, which could be obtained under sever deficit irrigation. However, such consequences on yield may not be tolerable from producers view point. The recommended depth of irrigation would be 75% ETc during development, bulb formation, maturity stages and skipping during initial growth stage. Skipping irrigation during maturity stages and irrigating with 75% ETc otherwise has more water saving and WP enhancement potential with tolerable level of yield reduction.

Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes

Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes

Live Donor Kidney Transplantation Outcomes Following Establishment of the First Kidney Transplant Center in Ethiopia

Live Donor Kidney Transplantation Outcomes Following Establishment of the First Kidney Transplant Center in Ethiopia

Profile and outcomes of women with pregnancy‐related acute kidney injury requiring dialysis at a center in Ethiopia

To describe the clinical profile and outcomes of women with pregnancy-related acute kidney injury (AKI) undergoing dialysis at Saint Paul's Hospital Millennium Medical College, Addis Ababa, where the first publicly funded large-scale dialysis service in Ethiopia was established. In a hospital-based retrospective study, clinical records were reviewed for all women with pregnancy-related AKI attending the hemodialysis unit at the study center between August 2013 and July 2015. In total, 42 pregnant women with pregnancy-related AKI underwent dialysis. Their mean age was 28.9±5.9years. The most common cause of pregnancy-related AKI was pre-eclampsia or eclampsia (31/42, 74%), followed by puerperal sepsis (6/42, 14%). The mean number of dialysis sessions was 4.8±4.6; the most common indication for dialysis was refractory fluid overload (35/42, 83%). Overall, 35 (83%) women were discharged with improvement, 5 (12%) died, and 2 (5%) absconded. Of the five maternal deaths, three women had pre-eclampsia-related AKI and two had puerperal sepsis-related AKI. Hypertensive disorders of pregnancy were the leading cause of pregnancy-related AKI, which can be easily prevented with early diagnosis and timely intervention. Improving the quality of prenatal care to recognize hypertensive disorders during pregnancy, coupled with prompt management, might help to reduce maternal morbidity and mortality related to AKI.

Determination of the sources and antimicrobial resistance patterns of Salmonella isolated from the poultry industry in Southern Ethiopia

BackgroundEthiopia set an ambitious masterplan to increase chicken meat and egg production from 2015 to 2020. Poultry breeding, multiplication and distribution centers in the country have received executive order to import, amplify and distribute commercial chickens to end users. The biosecurity and the pathogen fauna of the centers have not been evaluated as to whether the centers could implement the mission effectively without any risk. Thus, the aim of this study was to evaluate the biosecurity practices and the pathogen prevalence, risk factors and their antimicrobial resistance (AMR) using Salmonella as case study.MethodsRoutine farm workers of the centers were interviewed about the different management (biosecurity) practices using a checklist. Samples (n = 270) from different sources consisting of chicken’s cloacal swab (n = 244), personnel hand swab (n = 9) and bedding (n = 17) were collected from three chicken multiplication centers. Standard bacteriological methods were used for the isolation of Salmonella. Disk diffusion method was used for drug sensitivity testing.ResultsAntimicrobials were often over prescribed without confirming the cause of ill health and without susceptibility testing. The general biosecurity and flock management practices were substandard. Salmonella was isolated from 45 (16.7%) of the 270 samples. Its prevalence was significantly (p<0.05) associated with location of the multiplication center, 27% at Bonga and 10.6% at Hawassa. Sample type was also significantly (p<0.05) affected in that it was higher in the bedding (35.3%) and personnel hand swabs (33.3%) than in the chicken cloaca (14.8%), which demonstrates the poor biosecurity and personnel hygienic practices in the centers. All of the 45 isolates (100%) exhibited resistance to kanamycin and sulfamethoxazole-trimethoprim, nalidixic acid (97.8%), ampicillin (97.8%), cefoxitin (97.8%), streptomycin (97.8%) tetracycline (97.8%), chloramphenicol (91.3%), ciprofloxacin (31.1%), and gentamicin (0%). Alarmingly, 42 isolates (93.4%) exhibited multidrug resistance (MDR) to ≥ 8 drugs and all 45 isolates had resistance to ≥ 3 drugs. The high rate of Salmonella isolation from (i) bedding, (ii) personnel hand swabs (iii) chickens, (iv) presence of more MDR isolates, (v) coupled with poor biosecurity practices in the centers could pose a risk for spreading of pathogens and drug resistant genes to the smallholder chicken producers and the public.ConclusionsWe conclude that the poultry breeding, multiplication and distribution centers in Ethiopia, as they stand currently, seem to be a source of pathogens and AMR isolates at least for Salmonella. Therefore, strict biosecurity, personnel safety, prudent drug use, regular monitoring and traceability of Salmonella serotypes or genotypes and AMR are recommended.

Correlates of khat use during pregnancy: A cross-sectional study

ObjectivesKhat is widely used in East African countries including Ethiopia. A growing body of evidence indicates that long-term khat use is associated with various health consequences. The aim of this study was to examine the magnitude and correlates of khat use in pregnant women. MethodsThis study used a cross-sectional, face-to-face interview design that included 642 pregnant women receiving antenatal care services at primary care centers in Ethiopia. A series of chi-square tests and regression models were conducted to examine whether khat use status (i.e., 123 current khat users, 41 former khat users, and 478 non-users) was associated with socio-demographic, mental distress, and substance use measures. ResultsAs compared with non-users, current and former khat users had higher levels of depressive symptoms and distress. Khat users minimized potential health risks associated with khat use. Social and motivational factors related to khat use were different between current and former khat users. ConclusionsFindings of this study suggest a substantial prevalence of khat use among pregnant women in Ethiopia and highlight the role of socio-demographic and cultural influences on khat use during pregnancy. Health care professionals in the region where khat is available are encouraged to ask their female patients about khat use and encourage them to refrain from use while they are pregnant. The positive link between khat and mental distress warrants further research focusing on biological, psychological, and social mechanisms of this relationship.

Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes.

To describe the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia. The medical records of patients who underwent PKP at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The prespecified outcomes were graft survival, visual acuity, and complication rates. A total of 321 patients underwent PKP during the study period and were included in the analysis. Indications for surgery were trachoma or leukoma in 141 (44%), keratoconus in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), previous graft failure in 18 (6%), active ulcer, burn, or perforation in 9 (3%), and others in 7 (2%). The graft survival rate was 80% overall at 2 years but varied considerably depending on the indication for surgery. Uncorrected visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.09 (SD 0.67) to mean logarithm of the minimum angle of resolution of 1.53 (SD 1.03) at 2 years. A number of factors affected the visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses postoperatively. Complication rates were high with infectious keratitis being the most common. PKP is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.

Uncovering the Burden of Urologic Disease: Admissions Patterns at the Main Teaching Hospital of Ethiopia

Background: Limited data exists profiling the urologic needs of populations in sub-Saharan Africa. As the region builds training programs for urology, such data can inform strategic program planning and investment. The objective of this study was to describe admissions patterns for urologic disease at an academic medical center in Ethiopia. Methods: Retrospective review of admission, discharge, and operative logs of the urology service from November 2011 to October 2014 was conducted at Tikur Anbessa Specialized Hospital. Data were collected on patient demographics, length of hospital stay, specific diagnoses, condition classifications, and procedures performed, generating descriptive statistics. Results: A total of 1,149 urologic procedures were reviewed. Patients were predominantly male (74%) with median age of 43 years. The most common condition was urolithiasis (31%), followed by malignant tumors (25%) and benign tumors (14%). Almost half of patients underwent open surgical procedures (47%). Median inpatient stay was 14 days. Conclusions: The breadth and volume of patients treated hints at the large, unmet burden of urologic disease in Ethiopia. A large percentage of patients underwent open procedures and had prolonged inpatient lengths of stay. Continued research to understand urologic disease patterns and increase access to specialty care in this setting is needed.Keywords: Ethiopia; Sub-Saharan Africa; Urological Surgical Procedures; Health Care Utilization