Malaria Infection Has Spatial,Temporal, and Spatiotemporal Heterogeneity in Unstable Malaria Transmission Areas in Northwest Ethiopia

Background

Malaria elimination requires successful nationwide control efforts. Detecting the spatiotemporal distribution and mapping high-risk areas are useful to effectively target pockets of malaria endemic regions for interventions.

Objective

The aim of the study was to identify patterns of malaria distribution by space and time in unstable malaria transmission areas in northwest Ethiopia.

Methods

Data were retrieved from the monthly reports stored in the district malaria offices for the period between 2003 and 2012. Eighteen districts in the highland and fringe malaria areas were included and geo-coded for the purpose of this study. The spatial data were created in ArcGIS10 for each district. The Poisson model was used by applying Kulldorff methods using the SaTScan™ software to analyze the purely temporal, spatial and space-time clusters of malaria at a district levels.

Results

The study revealed that malaria case distribution has spatial, temporal, and spatiotemporal heterogeneity in unstable transmission areas. Most likely spatial malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR =197764.1, p<0.001). Significant spatiotemporal malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR=197764.1, p<0.001) between 2003/1/1 and 2012/12/31. A temporal scan statistics identified two high risk periods from 2009/1/1 to 2010/12/31 (LLR=72490.5, p<0.001) and from 2003/1/1 to 2005/12/31 (LLR=26988.7, p<0.001).

Conclusion

In unstable malaria transmission areas, detecting and considering the spatiotemporal heterogeneity would be useful to strengthen malaria control efforts and ultimately achieve elimination.     

Increasing Trends of Diabetes Mellitus and Body Weight: A Ten Year Observation at Gondar University Teaching Referral Hospital,Northwest Ethiopia

Background

Diabetes mellitus is becoming one of the major causes of premature adult mortality in developing countries. However, there is a very little documentation of the morbidity trend in such countries.

Objective

To assess the ten-year trend of diabetes mellitus at Gondar University Teaching Referral Hospital, northwest Ethiopia.

Methods

A hospital-based retrospective record review was done at the main referral hospital in northwest Ethiopia. Data were obtained from medical records of all registered diabetic patients in the Diabetic Follow up Clinic between 2000 and 2009. An Extended Mantel-Haenzel chi-square test for the linear trend was used to examine the trend over time.

Result

Out of the total 354,524 patients who visited the Outpatient Department of the hospital during the study period, 1553 (4.4/1000) were diabetes patients, of which 50.1% was type 1 and 49.9% type 2 diabetes mellitus. The average increase in the proportion of both Type 1 and Type 2 diabetes mellitus cases between 2000 and 2009 was 125%. The mean (±SD) age for Type 1 diabetes mellitus was 29.1 (±12), and 53.5 (±12) for Type 2 diabetes. Overall 42.5% of the diabetes mellitus patients were female and 31.7% were rural residents. The mean body mass index for both type of diabetes mellitus increased from 15.9 to 18.3 kg for type 1 and from 23.8 to 24.6 for type 2 between 2000 and 2009, respectively.

Conclusion

The number of diabetes mellitus cases seen at Gondar Referral Hospital is rising steadily. A comprehensive diabetes prevention, treatment, and care program is needed to improve the quality of life of the increasing diabetes mellitus cases in Ethiopia.     

Half of Pulmonary Tuberculosis Cases Were Left Undiagnosed in Prisons of the Tigray Region of Ethiopia: Implications for Tuberculosis Control

Introduction

Prison settings have been often identified as important but neglected reservoirs for TB. This study was designed to determine the prevalence of undiagnosed pulmonary TB and assess the potential risk factors for such TB cases in prisons of the Tigray region.

Method

A cross-sectional study was conducted between August 2013 and February 2014 in nine prisons. A standardized symptom-based questionnaire was initially used to identify presumptive TB cases. From each, three consecutive sputum samples were collected for acid-fast bacilli (AFB) microscopy and culture. Blood samples were collected from consented participants for HIV testing.

Result

Out of 809 presumptive TB cases with culture result, 4.0% (95% CI: 2.65–5.35) were confirmed to have undiagnosed TB. The overall estimated point prevalence of undiagnosed TB was found to be 505/100,000 prisoners (95% CI: 360–640). Together with the 27 patients who were already on treatment, the overall estimated point prevalence of TB would be 793/100,000 prisoners (95% CI: 610–970), about four times higher than in the general population. The ratio of active to passive case detection was 1.18:1. The prevalence of HIV was 4.4% (36/809) among presumptive TB cases and 6.3% (2/32) among undiagnosed TB cases. In a multivariate logistic regression analysis, chewing Khat (adjusted OR = 2.81; 95% CI: 1.02–7.75) and having had a close contact with a TB patient (adjusted OR = 2.18; 95% CI: 1.05–4.51) were found to be predictors of undiagnosed TB among presumptive TB cases.

Conclusions

This study revealed that at least half of symptomatic pulmonary TB cases in Northern Ethiopian prisons remain undiagnosed and hence untreated. The prevalence of undiagnosed TB in the study prisons was more than two folds higher than in the general population of Tigray. This may indicate the need for more investment and commitment to improving TB case detection in the study prisons.     

Karyometric image analysis for intraepithelial and invasive cervical lesions

OBJECTIVE: To derive an objective, numeric measure for the progression of intraepithelial and invasive squamous cell cervical lesions. STUDY DESIGN: Thin-layer cervical cytology preparations from colposcopically confirmed normal cervix, low grade squamous intraepithelial lesions, high grade squamous intraepithelial lesions and carcinoma were identified from a cross-sectional study. Fifty-nine cases representing 4 diagnostic categories were selected, and 2,375 nuclei from epithelial cells representative of the diagnostic category were randomly selected for imaging and measurement from these cases. Additionally, 1,378 visually normal appearing intermediate cells from low and high grade squamous intraepithelial lesions, as well as from carcinoma cases, were identified for analysis. The nuclei were quantitatively characterized, and discriminant analyses were performed to derive a progression curve from normal cytology to carcinoma. RESULTS: The lesion signatures show a clear increase in nuclear abnormality with increasing progression. A progression curve was derived based on mean discriminant function scores for each diagnostic category and on the mean nuclear abnormality values for the nuclei in each category, as expressed by their deviation in feature values from normal reference nuclei. CONCLUSION: A numeric assessment of lesion progression for cervical precancerous and cancerous lesions based on karyometric measurements is possible and may provide an objective, precise characterization of each lesion as well as a basis for improved performance in automated cytology-based cervical cancer screening.     

Genetic diversity of <Emphasis Type="Italic">Microcystis</Emphasis> blooms (Cyanobacteria) in recently constructed reservoirs in Tigray (Northern Ethiopia) assessed by rDNA ITS

The cyanobacterium Microcystis is notorious for forming extensive and potentially toxic blooms in nutrient-rich freshwater bodies worldwide. However, little is known about the factors underlying the genetic diversity and structure of natural Microcystis populations, despite the fact that this knowledge is essential to understand the build-up of blooms. Microcystis blooms are common and occur year-round in Africa, but are underinvestigated in this continent. We studied the genetic diversity and structure of Microcystis populations in 30 man-made reservoirs in Tigray (Northern Ethiopia) using Denaturing Gradient Gel Electrophoresis of the 16S–23S rDNA internal transcribed spacer (ITS) region and assessed the importance of local environmental conditions and geographic position of the reservoirs for the observed patterns. The analyses showed that both regional and local Microcystis ITS diversity in these recently constructed reservoirs was relatively low, with several dense blooms containing only a single ITS type. Especially one non-toxic ITS type dominated a considerable fraction of Microcystis blooms, but appeared restricted in its geographic distribution. The relationship between Microcystis ITS population structure and abiotic variables (water clarity, pH) and with zooplankton (Daphnia biomass) indicates a (limited) influence of environmental conditions on Microcystis population structure in the reservoirs of Tigray.     

Analysis of household's energy consumption,forest degradation and plantation requirements in Eastern Tigray,Northern Ethiopia

This study examines the link between household's energy consumption, forest degradation and plantation requirements in Eastern Tigray. Data on household's fuelwood, cow‐dung, kerosene and electricity consumption in the study sites were collected from 557 urban and 114 rural households. Deforestation rate was estimated following FAO and Woody Biomass Inventory Strategy Planning Project (WBISPP's) conversion factors. The study showed that household's fuelwood consumption in urban areas (mean = 2.5 kg/day) was about 52% lower as compared to the rural villages (mean = 3.8 kg/day). The estimated area abandoned annually in the vicinity of urban areas as the result of urban fuelwood consumption varies from 217 ha around Maichew town to 12047 ha around Mekelle City. The estimated area abandoned in rural areas annually as the result of tree cutting for fuelwood also varies from 6.5 ha around Sinkata to 127 ha around Dergajen village. It is therefore recommended that an estimated annual tree plantation of area ranging from 286 ha around Maichew town to 21,684 ha around Mekelle city is required. Moreover, an estimated annual tree plantation of area ranging from 16 ha around Sinkata village to 229 ha around the Dergajen village is required taking the existing population into account.     

Assessing changes in the distribution and range size of demersal fish populations in the Benguela Current Large Marine Ecosystem

Distributional change, expressed as range expansion or contraction , has been observed in many marine populations and related to changes in the environment. The extent of such distributional changes is also expected to increase in response to future climate change. The Benguela Current Large Marine Ecosystem (BCLME) which adjoins the south-western coast of Africa is a global marine hotspot with long-term warming occurring over a large area. The area is also an important centre of marine food production for three countries—South Africa, Namibia and Angola and is considered to be vulnerable to future climate change or increased climate variability. In this study we analysed change in distribution and range size of several demersal fish species in the BCLME over the period 1985–2010, including both commercial and non-commercial fish populations. Some of the observed changes in distribution and range size correspond to what is expected with increased warming whereas others appear to the contrary. Overall the results of the study highlight the complex nature of the response of fish population to climate change.     

Construct Validity and Factor Structure of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale in a Multi-National Study of African,South East Asian and South American College Students

Background

The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are questionnaires used to assess sleep quality and excessive daytime sleepiness in clinical and population-based studies. The present study aimed to evaluate the construct validity and factor structure of the PSQI and ESS questionnaires among young adults in four countries (Chile, Ethiopia, Peru and Thailand).

Methods

A cross-sectional study was conducted among 8,481 undergraduate students. Students were invited to complete a self-administered questionnaire that collected information about lifestyle, demographic, and sleep characteristics. In each country, the construct validity and factorial structures of PSQI and ESS questionnaires were tested through exploratory and confirmatory factor analyses (EFA and CFA).

Results

The largest component-total correlation coefficient for sleep quality as assessed using PSQI was noted in Chile (r = 0.71) while the smallest component-total correlation coefficient was noted for sleep medication use in Peru (r = 0.28). The largest component-total correlation coefficient for excessive daytime sleepiness as assessed using ESS was found for item 1 (sitting/reading) in Chile (r = 0.65) while the lowest item-total correlation was observed for item 6 (sitting and talking to someone) in Thailand (r = 0.35). Using both EFA and CFA a two-factor model was found for PSQI questionnaire in Chile, Ethiopia and Thailand while a three-factor model was found for Peru. For the ESS questionnaire, we noted two factors for all four countries

Conclusion

Overall, we documented cross-cultural comparability of sleep quality and excessive daytime sleepiness measures using the PSQI and ESS questionnaires among Asian, South American and African young adults. Although both the PSQI and ESS were originally developed as single-factor questionnaires, the results of our EFA and CFA revealed the multi- dimensionality of the scales suggesting limited usefulness of the global PSQI and ESS scores to assess sleep quality and excessive daytime sleepiness.     

Farmers’ Management of Finger Millet (Eleusine coracana L.) diversity in Tigray, Ethiopia and Implications for on-Farm Conservation

Tigray (region) is one of the major finger millet growing regions in Ethiopia and an important site from an archeobotanical point of view. Three zones of Tigray (east, central and west) were identified as representative sites in the region and a total of 14 districts/ ‘Woreda’ were surveyed. Thirty-seven landraces/farmers’ varieties of finger millet were identified/recorded. Farmers in Tigray undertake pre and post harvest selection in finger millet and sometimes they also select seeds from storage based on a number of attributes. Farmers maintain diversity as a way to ensure harvest security or stability of production, to promote diversity of diet and income sources, minimize crop failure risk, reduce insect and disease incidences and ensure efficient use of labour. The traditional management of finger millet in the entire study area is generally found to be demand driven, showing the existence of potential sites for on-farm conservation. The high morphological diversity (H =0.76 ± 0.09) found in the gene bank collections of Tigrayan origin also reveals the importance of linking ex situ with in situ conservation activities. Furthermore, the enhancement and conservation significance of the crop is discussed.     

Prevalence and Associated Factors of Hypertension: A Crossectional Community Based Study in Northwest Ethiopia

Background

Hypertension, being the root cause of many of the body sytem and organs failure, remains to be a major public health challenge globally. Though the problem is huge in both developed and developing countries, data are scarce in developing countries like Ethiopia. Therefore, this study was aimed to determine the magnitude and associated factors of hypertension in North West Ethiopia.

Methods

A cross-sectional survey was conducted on adults aged 35 years and above in the rural and urban communities of Dabat district and Gondar town in 2012. The data were collected using the WHO STEPwise strategy. Hypertension was defined as having a Systolic blood pressure of ≥140 mmHg and/ or a Diastolic BP of ≥ 90mmHg or a reported use of anti-hypertensive medications for raised blood pressure. Prevalence was computed with a 95% confidence interval. Selected risk factors were assessed using a biviarete logistic regression.

Results

A total of 2200 participants were included in the study. The median age (±SD) was 47 (±12.4) years. The overall prevalence of hypertension was found to be 27.9% [95% CI 26.0, 29.8], with the proportion in the urban and rural residents being 30.7% and 25.3% respectively. The prevalence of hypertension was 29.3% for women and 26.3% for men. Out of the 598 hypertensive patients 241 (40.3%) had blood pressure measurements, and 99 (16.6%) had known hypertension and were on treatment. The proportion of systolic and diastolic hypertension in this subgroup of adults was 133(6.2%). The multivariable logistic regression analysis showed older age (AOR = 1.06; 1.05, 1.07), raised fasting glucose (AOR = 1.01; 1.001, 1.01), alcohol consumption (AOR = 1.71; 1.24, 2.36), and raised BMI (AOR =1.07; 1.04, 1.10) were significantly associated with hypertension.

Conclusion

The prevalence of hypertension was considerably higher in rural areas than previously reported. The health system needs to develop strategies to increase the reach of relevant screening and diagnostic services to both rural and urban populations.